In no other country has health care served as such a volatile flashpoint of ideological conflict. America has endured a century of rancorous debate on health insurance, and despite the passage of legislation in 2010, the battle is not yet over. This book is a history of how and why the United States became so stubbornly different in health care, presented by an expert with unsurpassed knowledge of the issues.
Tracing health-care reform from its beginnings to its current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap through policies that satisfied enough of the public and so enriched the health-care industry as to make the system difficult to change.
He reveals the inside story of the rise and fall of the Clinton health plan in the early 1990s—and of the Gingrich counterrevolution that followed. And he explains the curious tale of how Mitt Romney’s reforms in Massachusetts became a model for Democrats and then follows both the passage of those reforms under Obama and the explosive reaction they elicited from conservatives. Writing concisely and with an even hand, the author offers exactly what is needed as the debate continues—a penetrating account of how health care became such treacherous terrain in American politics.
|Publisher:||Yale University Press|
|Sold by:||Barnes & Noble|
|File size:||852 KB|
About the Author
Table of Contents
Preface to the Revised Edition xi
Preface and Acknowledgments xiii
Introduction: An Uneasy Victory 1
The Making of a National Impasse 3
A Window for Reform 12
Choices and Vulnerabilities 17
Part I The Genealogy of Health-Care Reform
1 Evolution through Defeat 27
Progressive Health Insurance, 1915-1919 29
The New Deal and National Health Insurance, 1935-1950 35
The Growth of the Protected Public, 1950-1965 41
2 Stumbling toward Comprehensive Reform 51
Political Deadlock, 1969-1980 52
Political Reversals, 1981-1990 63
The American Path in Health Insurance 72
Part II Frustrated Ambitions, Liberal and Conservative
3 The Shaping of the Clinton Health Plan, 1991-1993 79
A New Framework 83
Clinton's Decisions 90
4 Getting to No, 1994 103
The Democrats' Disorder 104
The Big Turnabout 112
The Collapse of Congressional Compromise 119
Why No Reform? 122
5 Comes the Counterrevolution, 1995-2006 129
Gingrich and the End of Entitlements 131
From Bold Leaps to Baby Steps 138
A Republican Window 146
Return to Crisis 155
Part III Rollercoaster
6 The Rise of a Reform Consensus, 2006-2008 161
Romney and the Massachusetts Model 163
Toward Minimally Invasive Reform 174
Making 2008 a Health-Care Election 182
Prepare to Launch 190
7 Breaking Through, 2009-2010 194
Health Care First 196
Bipartisanship in One Party 201
Reaction and Resolve 211
Obama and the Rollercoaster to Reform 220
Why Health-Care Reform Passed (and Climate Legislation Didn't) 235
8 The Affordable Care Act as Public Philosophy 239
Fairness and Equality 241
Responsibility and Freedom 247
Federalism and Finance 252
Health and the Public Household 259
9 Reform's Uncertain Fate 267
The Politics of Slow Implementation, 2010-2011 269
The Supreme Court Rules 278
Another Election, Another Survival Test 286
The Peculiar Struggle 296
What People are Saying About This
Paul Starr, who gave us a magisterial account of the history of American medicine, now has given us the definitive account of the history of the struggle to enact health reform in America. Starr has done more than just study reform—he was a player in efforts to achieve it. Remedy and Reaction is in some ways thus an insider's history, which only enriches the experience of the reader. This book is a lively read, but has depth and insight. From its account of the early experiences in the twentieth century with reform, up through the disappointments in our livetimes to achieve any comprehensive change, through the enactment of the Affordable Care Act and the story of its uncertain future, Remedy and Reaction is the definitive account of the history of health reform in America.—Norman Ornstein, co-author of The Broken Branch: How Congress Is Failing America and How to Get it Back on Track
Paul Starr has written a fascinating chronicle of America’s century-long journey to health reform that is, at once, erudite history, vivid journalism, and authoritative guide to a debate that will continue for decades.—Henry J. Aaron, co-author of Using Taxes to Reform Health Care
Few books as important as this one is are as clearly and compellingly written. Remedy and Reaction is a brilliant analysis of the political conflicts and compromises that led to the passage of the Affordable Care Act, and a fitting sequel to Paul Starr's masterful book, The Social Transformation of American Medicine. The final page came much too soon.—Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer
Here’s the book we’ve been waiting for—a lucid history of America’s struggle over healthcare reform, blending the political, economic, and social pressures that have brought us to where we are, and suggesting where we’re headed. With great insight and impeccable writing, Paul Starr explains why that struggle has been particularly bitter and partisan in the United States, why the resulting compromises have left so many people unsatisfied, and why the underlying problems continue to evade us. Brilliant and important.—Robert B. Reich, Chancellor's Professor of Public Policy, Goldman School of Public Policy, University of California, Berkeley
Remedy and Reaction is the story of health care in America, told by the man who knows it best. Whether you're a serious scholar or just a serious citizen, you should read this.—Jonathan Cohn, senior editor, The New Republic
Three decades ago Paul Starr wrote the definitive history of American medicine. Remedy and Reaction now offers the definitive analysis of American health care reform—its history, nature, and continuing vulnerability.—Timothy Jost, co-editor, Transforming American Medicine: A Twenty Year Retrospective
What do you most want people to understand from reading this book?
I hope the book illuminates how an issue that is more or less settled in every other democracy became a seemingly intractable political problem in the United States.
It did not have to turn out this way. The legislation adopted in 2010 has its roots in moderate Republican proposals. But America’s polarized politics make it difficult to see the reforms clearly and put them in historical perspective. I hope the book helps to provide that understanding.
What’s the relationship of Remedy and Reaction to your 1984 book, The Social Transformation of American Medicine?
In some ways it’s a sequel, but each of its three parts has a somewhat different foundation. Part One, about how health-care reform and the health-care system took shape during the twentieth century, presents the same kind of social and historical analysis as Social Transformation did.
But Part Two, which deals with the parallel stories of the Clinton health plan and Republican health reforms in the Gingrich and Bush years, also reflects my observations inside the Clinton White House. That’s a kind of experience not usually available to historians.
Finally, Part Three, about the battle over health-care reform under Obama, combines journalism and historical analysis because it draws on interviews with participants, many of whom I know from my prior time in Washington.
Why did Obama succeed where Clinton failed?
Between 1993 and 2009, the biggest change was the emergence of a consensus about the basic elements of legislation among reformers, major interest groups, and leading Democrats in Congress. The reforms adopted in Massachusetts in 2006 as a result of Mitt Romney’s leadership were critical in shaping that consensus. Obama accepted that approach; he didn’t originate it. Romney probably deserves more credit for the basic architecture of the national reforms, and I hope one day he proudly accepts that credit.
Didn’t Obama’s leadership matter?
If Obama hadn’t decided to make health-care reform a priority as president, it would never have passed. Why did he take it on? His earlier history didn’t indicate a deep commitment to health-care reform. I think the 2008 presidential campaign was crucial because of the pressure from the party base to confront the issue, plus an accident of history: he ran into Hillary Clinton on the way to the nomination, and debating her forced him to master health policy. Perhaps most important, the support for reform from key stakeholder groups and members of Congress changed the political calculus on health care. That’s what made it a better bet than climate legislation.
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