Ezekiel J. Emanuel - Reinventing American Health Care: How the Affordable Care ACT Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System

Praise for

Reinventing American Healthcare

For Americans poisoned by nefarious medical insurance companies and aGOP dying to gut Obamacare, I prescribe Ezekiel Emanuels Reinventing AmericanHealth Care clarify how the Affordable Care Act can rehabilitate our nauseatinglyunjust, grossly expensive, and senselessly complicated health-caresystem. My personal recommendation? Lay off the toxic propaganda.Vanity Fair

Whether you agree with his conclusions or not, theyre well argued, and hehas marshaled an impressive amount of information.Washington Post

Infused with diagrams, charts, and tables, this book is informative, thought-provoking,and immensely important. Given his role in the program, and as isreflected in the subtitle of the book, Emanuel clearly wants to persuade, buthe also wants to explain. And because he was an insiderand proves himselfa gifted writerhe makes an able guide to the complexities of the landmarklegislation... Clearly, if Obamacare is to fulfill its promise there will need to besignificant changes and that will require collaboration among citizens, healthcare professionals, scholars, and lawmakers from across the political spectrum.And the only way this can happen is if people understand what exactly is atstake. Reinventing American Health Care spells this out clearly, and by doing so,lays the foundation for this kind of collaboration to occur.Dennis Rosen, Boston Globe

The facts and history that Emanuel lays out would be useful to anyone involvedin the debate over health care, no matter what their point of view is.Health Affairs

With this book, Zeke Emanuel has done the country an immense service.He does the impossibleexplains the dysfunctional American health-care systemand then takes it one better. For here he also makes the hard-eyed casefor understanding that the passage of health reformof Obamacarehas setus on a path for a health system that works. Our system has left millions withoutneeded care, bankrupt, or both, and tied the fate of their health to wherethey work. This book explains how we got in this fix, how we will get out ofitand even more boldly, when. If you wanted to read one book to understandhealth care, this is the one you want.Atul Gawande, surgeon, staff writer for The New Yorker,and author of The Checklist Manifesto

There are thoughtful doctors, savvy policy makers and profound scholars ofmorality. Zeke Emanuel is the only person in America who is all three. Thatmakes him the right person to write the definitive primer on health care inAmerica. It should be read by anyone who wants to understand what may bethe most important set of domestic issues facing America.Lawrence H. Summers, former Secretary of theTreasury of the United States, & President Emeritus andCharles W. Eliot University Professor of Harvard University

Zeke Emanuel has written a book that tells people interested health-carepolicy what they need to know but all too often do not. He brings togethera staggering variety of information, never before available in one place, oneconomics, medicine, legislative history, governmental operations, politics,and the gory, boring, and surpassingly important issue of implementation. Nosingle book can tell one all one needs to know about the most complex healthcaresystem in the world, but this one comes very close indeed.Henry J. Aaron, the Bruce and Virginia MacLaurySenior Fellow in the Economic Studies programat the Brookings Institution

The author, who serves as a special White House adviser on health care reform,is optimistic that its glitches will be resolved within the year and that itwill transform how patients are cared for over the coming decades... He offersan insiders account of some of the infighting that occurred within the Obamaadministration... The author takes a long view of the reforms beginning withincentives and penalties for the adoption of uniform electronic health recordsin the 2009 Recovery Act... An important challenge to the naysayers on bothsides of the political divide.Kirkus Reviews

Prominent bioethicist Emanuel makes a convincing, albeit onesided, case foroverhauling what he sees as an unfair health system in the US. Deftly usingnumbers to make his arguments, Emanuel organizes his book into three parts:the current system (largely its financing), health-care reform (the nearly 1,000-page Affordable Care Act [ACA] and legal challenges to it), and the future (lotsof hospital closings)... He also touches on important history (the creation ofMedicare in 1965) and clearly explains complicated issues... A plain-Englishexplanation of a tricky topic.Booklist

Few people have had a more favorable influence on the shaping of the currentprocesses of health care reform than Zeke Emanuel has. And no one is a better,clearer, or wiser interpreter of the insanely complex non-system that we aretrying to fix. This book is an instant classicmandatory reading for anyonewho wants to know how we got where we are in American health care andwhere we need to go.Donald M. Berwick, MD, MPP, president emeritus andsenior fellow at the Institute for Healthcare Improvement, and formeradministrator of the Centers for Medicare and Medicaid Services

Reinventing American Health Care is an informed and informative book andlikely to be just as controversial as Zeke Emanuel was during his tenure in theObama administration.Gail Wilensky, senior fellow at Project HOPE and former deputyassistant to President George H. W. Bush for policy development

REINVENTING

AMERICAN

HEALTH CARE

Copyright 2014 by Ezekiel J. Emanuel.

Published in the United States by PublicAffairs, a Member of the Perseus Books Group

All rights reserved.

First paperback edition published in 2015 by PublicAffairs.

No part of this book may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, address PublicAffairs, 250 West 57th Street, 15th Floor, New York, NY 10107.

PublicAffairs books are available at special discounts for bulk purchases in the U.S. by corporations, institutions, and other organizations. For more information, please contact the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street, Suite 200, Philadelphia, PA 19103, call (800) 810-4145, ext. 5000, or e-mail .

Editorial production by Marrathon Production Services. www.marrathon.net

Book design by Jane Raese

Set in 12-point Dante

Library of Congress Cataloging-in-Publication Data

Emanuel, Ezekiel J., 1957 author.

Reinventing American health care : how the Affordable Care Act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system / Ezekiel J. Emanuel. First edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-61039-346-1 (e-book)

I. Title. [DNLM: 1. United States. Patient Protection and Affordable Care Act. 2. Health Care ReformUnited States. 3. Health ServicesUnited States. 4. Health Services AdministrationUnited States. 5. National Health ProgramseconomicsUnited States. WA 540 AA1]

RA413

362.10425dc23

2013049343

10 9 8 7 6 5 4 3 2 1

DISCLAIMER

Health care is dynamic. Though progress can seem maddeningly slow, the system is constantly reinventing itself. The cost estimates, enrollment numbers, and other data in this book were accurate as of December 1, 2013when I stopped writing. Accurate is a matter of degree since different government agencies often report different numbers for the same data point and private organizations often have other numbers. We have done our best to comes as close as possible to reality. Complicating things even more is that health care is changing rapidly. The Supreme Court will agree to hear new cases related to health care, the Medicare actuary will issue new reports on cost growth in Medicare and Medicaid and the overall rate of health care inflation, the Congressional Budget Office will publish new estimates of long-term health care costs and their impact on the federal budget, and policymakers in Washington will craft new policy fixes and stake out new positions. It is possible that these or other changes could alter some of the trends, detailed numbers, and specific predictions discussed throughout this book. Nevertheless, the direction of change and what statisticians call the central tendencies are unlikely to be significantly altered.