Priced Out: The Economic and Ethical Costs of American Health Care

Priced Out: The Economic and Ethical Costs of American Health Care


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From a giant of health care policy, an engaging and enlightening account of why American health care is so expensive—and why it doesn't have to be

Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of today's U.S. health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it.

The problem, Reinhardt says, is not one of economics but of social ethics. There is no American political consensus on a fundamental question other countries settled long ago: to what extent should we be our brothers' and sisters' keepers when it comes to health care? Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America finances health care, and he offers a penetrating ethical analysis of recent reform proposals. At this point, he argues, the United States appears to have three stark choices: the government can make the rich help pay for the health care of the poor, ration care by income, or control costs. Reinhardt proposes an alternative path: that by age 26 all Americans must choose either to join an insurance arrangement with community-rated premiums, or take a chance on being uninsured or relying on a health insurance market that charges premiums based on health status.

An incisive look at the American health care system, Priced Out dispels the confusion, ignorance, myths, and misinformation that hinder effective reform.

Product Details

ISBN-13: 9780691192178
Publisher: Princeton University Press
Publication date: 05/14/2019
Pages: 232
Sales rank: 68,702
Product dimensions: 6.10(w) x 9.10(h) x 1.00(d)

About the Author

Uwe E. Reinhardt (1937–2017) was the James Madison Professor of Political Economy and Professor of Economics and Public Affairs at Princeton University, where he taught for nearly fifty years. He wrote a regular column for the New York Times blog Economix.

Table of Contents

Foreword Paul Krugman ix

Foreword Senator William H. Frist, MD xv

Prologue xxiii

Introduction 1

I A Visual Stroll through America's Health Care Wonderland

1 US. Health Spending and What Drives It 13

2 Pricing Americans Out of Health Care 41

3 Some Interesting or Curious Facts about Our Health Care System 47

4 Who Actually Pays for Health Care? 62

5 Value for the Money Spent on U.S. Health Care 69

II Ethical Perspectives on U.S. Health Care

6 The Social Role of Health Care 81

7 The Mechanics of Commercial Health Insurance from an Ethical Perspective 85

8 The Elephant in the Room and the Ethical Vision Baked into Health Reform Proposals 99

9 The Ethical Vision of the Affordable Care Act of 2010 (Obamacare) 102

10 The Ethical Vision of the Health Reform Proposals of 2017 110

Conclusion: A Novel (My Own) Reform Proposal 135

Epilogue Tsung-Mei Cheng 139

Acknowledgments Tsung-Mei Cheng 169

Notes 173

Index 191

What People are Saying About This

From the Publisher

"Uwe Reinhardt was the moral conscience of our health care system, reminding us with evidence, clarity, and stand-up act humor how it is failing. He was joined in this enterprise by another great health care expert, his wife, Tsung-Mei Cheng. Every health care group craved Reinhardt as their keynote speaker and felt more virtuous after he berated them about the many ways in which they were failing. But he did not want adulation; he wanted things to change. By reading this powerful book and making something in the health system better, we can all honor his legacy."—Drew Altman, President and CEO, Henry J. Kaiser Family Foundation

"As always, Uwe Reinhardt has managed to make me smile as he's presenting a tragic story about U.S. health care. He couples an economist's mathematical graphs and analysis with his unique, unsparing wry commentary. You can hear him on every page of this book. Demonstrating the infeasibility of many—actually, almost all—of the recent attempts at health care reform, he avers that Republican loss of control of one or both houses in 2018 would 'change the debate on health care.' He predicts 'major competing initiatives on health care' from both parties in the 2020 campaign. It is a tragedy that he will not be here to analyze them."—Elisabeth Rosenthal, Editor-in-Chief, Kaiser Health News, and author of An American Sickness

"With an economist's precision and a prophet's moral clarity, the late Uwe Reinhardt untangles our complex health care system for all to see and understand. Only Reinhardt could have done so much in such a short, penetrating volume. His brilliance as a teacher shines through. This will be a must-read for aspiring students of health care and for policymakers everywhere. How much we will miss him."—David Blumenthal, MD, President, The Commonwealth Fund

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