And the Fight to Fix Our Broken Healthcare System

Brill presents the planning and launch of the Affordable Care Act "Obamacare" with a remarkable insider's view. You will be torn between contempt for the process and admiration for some of the players. I was entertained and informed.

Fascinating inside look at the birth of Obamacare. Author comes across as very objective journalist with no ideological ax to grind. If you want to educate yourself on the complex issues of health care reform, this is the perfect primer.

I just started reading this book (the Kindle Version), so I can't really 'finalize' this review on 'content'. But one complaint I do have already (which I consider to be significant) is the number of runnn-onnn sentences the author uses when making a point. I thought I was having trouble comprehending because I was tired last night, but this morning it was the same - I still found myself having to read and reread paragraphs over and over again to grasp some understanding of a sentence that could travel on indefinitely.

The author uses dashes and commas A LOT. Sometimes commas aren't included, when they're needed to punctuate the thought process. Other times commas are used in places they don't belong. Bad punctuation makes for broken/choppy reading.

Hope the content makes up for this, and then I may change my review. Just be prepared to stumble through occasionally, especially if you're a person who needs sentence structure and proper punctuation to comprehend. At times I had trouble believing he was making a living writing.

America's Bitter Pill shows us the incredible corruption and greed in our government, pharmaceutical companies
and "not for profit" hospitals. While billions of dollars are being made, the taxpayer is forced to bear one more
burden for another bloated government run program.

The author, by means of an engaging narrative style that traces his own dramatic patient experience and the tortured course and political struggles to enact ACA (Obamacare), succeeds in capturing our interest and understanding in the disorder of our healthcare system and how we might think about routes to a 'cure'.

Very good read about the creation of Obamacare and the state of the US healthcare system. Certainly informative. But plenty of holes too. In evaluating the cost of certain high priced drugs, the author fails the cost and the benefit (i.e. a new hepatitis drug requires 84 treatments at $1000 per pill or $84,000 to cure the disease. But what is the cost of the next best treatment and timeframe to get the samee results?) It is aggravvating that drug companies charge US consumers much higher prices than consumers in other countries. Should not be the case. And it was illuminating to see how hospitals price items depending on the insurance of the patient. Rip offs. Finally, the politics and bargaining necessary to ram gigantic Obamacare theough is disgusting. There must be a better way

I felt that this book was an extremely informative piece by a fine writer. I don't have enough background knowledge on this subject to critique its substance, but I feel pretty confident that the basic data and salient facts presented by Brill are true, so the questions might be more about his interpretation of them. Overall, I recommend this book as a good starting point for anyone who wants to know more about this important subject.

The first two sections of this book are excellent, shedding bright light on the path we took to arrive at Health Care Reform/Obamacare. It was well written, well researched and well thought out.

Sadly, the final two sections of the book are not as crisp. Section 3 is cumbersome and difficult to absorb. It is reads like a recollection of tales of what caused the Healthcare.gov website to fail and how that was fixed. A little bit of attention is given to evolving policies that weakened the ACA but it was hard to slog through all the uninteresting minutia and behind-the-scenes reporting. Section 3 needs an edit.

The 4th and final section is the author's opinion on how he might fix the healthcare system in America. I don't agree with much of what is written and I found it to be overall somewhat naive. The solutions presented might work in a big urban center, but would be valueless to the many slightly populated counties throughout the nation. Those areas would be underserved even more substantially than they are at present. Furthermore, how anyone can suggest that a healthcare administrator should be entitled to earn no more than 60 times the salary of its lowest paid medical professional is laughable. 60 times? No wonder we can't afford a trip to the doctor! How about capping that at say, not more than the salary of the highest paid physician or better yet, not more than the salary of say, POTUS?

Blame the insurance companies all you want, people, but they are not the true enemy here. It's the hospital organizations, the drug companies, and the medical device/equipment suppliers. The insurance companies have been trying to hold the beast at bay by limiting payments. Hospitals cry foul, but honestly, did you know that the director of the non-profit hospital you made that donation to last year was earning more than a million or so bucks? Probably not.

Isn't it DISGRACEFUL that hospitals come to us, hat in hand, for donations yet when we arrive without the ability to pay, they take that donation money and hire attorneys?

The greatest takeaway I have from this book is reinforcement that our medical system must be shifted away from a capitalist structure and made into a public health system. For those who have lots of cash on hand, they can create their own, elite hospitals and pay for them directly. I won't participate. If you consider that we already have these types of elitist medical entities operating right under our noses, those of us without the means to pay won't be in any different position than we are today.

There was one argument in the book that drove this home: a man from Ohio with cancer was showcased as a case study for Obamacare. This man, when his cancer was first discovered, would settle for nothing less than a trip to MD Anderson Cancer Center in Houston for care. His insurance at the time would have covered a substantial amount of his initial care had he stayed home in Indiana and sought care at a less prestigious entity, but he refused and instead came out of pocket many thousands of dollars for his initial treatments.

When he and his wife later became eligible for Medicaid, they were gushing at the incredible savings they'd enjoy, but the fact that they couldn't go to MD Anderson was no longer a big deal to them - they'd just stay local. Well, I ask why they didn't reach this conclusion the first time? Honestly, this is the problem I see with people and healthcare. They all want the best, but want to pay for the least costly insurance and complain when that care is limited because they didn't shell out for a plan with richer benefits. If the Medicaid based local hospital was good enough when it is free, why wasn't it good enough when you the $50k to give it in the first place.

Let's face facts: Obamacare is change, but not for the better. Yes, many more people now have insurance but even more people can no longer afford their insurance or the deductibles and co-insurance associated with it. The networks are very narrow as are the formularies. Pay attention, folks. This is what Obamacare bought us. We could have achieved the same simply by expanding Medicaid and creating a pool of high risk insurers for the chronically ill. Or, we can wake up and create a true single payer system before the country is bankrupted.

While at points this book was like trudging throughg water to get through, I'm glad I read it to get a bit of a better idea of how the ACA came to be and everything that went on good and most,y bad that made it be. The authors ideas in the last chapter about where healthcare should go are also worth reading.

Masterpiece!! Buy this book today if you are interested in America, Obamacare, our government and the healthcare system. Brill's style is lucid and incredibly informative. He elucidates the many problems involved with the development of Obamacare. He deeply analyzes the myriad of problems with American healthcare and offers solutions to bring down the costs. I think that interviewing doctors, nurses, healthcare workers and patients would be a great follow-up to this work and would compliment it immensely. Many of the most serious problems with healthcare involve corrupt, greedy administrators who exploit doctors and nurses who have little protection. Some hospitals are severely dysfunctional institutions where there is virtually no administrative accountability. Workers and patients are being harmed, especially in the present cost-cutting and desperate profit-seeking environment. Hospital trustees are sometimes in bed with hospital administrators further crippling accountability. Revealing and changing this incredibly dysfunctional hospital culture will shed light on the many improvements that can be made to improve quality and potentially decrease costs. Brill has exposed the financial problems with healthcare. It's time to expose the healthcare culture from the inside out.

The book started out rather interesting. Telling about the struggles within the confines of our government to get the bill passed. Then after the story was told it became a bit dry with discussions about how to fix the situation. I could not get my head around the solution.

This book uses the backdrop of the obamacare campaign and implementation to give readers an inside look at the healthcare industry. It's size, entrenched lobbying, and various benefactors explains all too easily why we have a ways to go before we will see true reform and results .

A tedious, mind numbing look at how things get done (and don't) in Congress and the White House. In this case, clearly politics should be removed from health care for all Americans; so too, all lobbyists and those who accept their bribes should be removed from involvement with any aspect of decision making regarding legislation pertaining to health care.

A fascinating, and depressing, read. The author walks us through the lobbying, negotiation, legislation and implementation of Obamacare. This is more helpful than the final section, in which the author lays out his own proposals for changing the healthcare system (regulated, vertically integrated oligopolies).

This is a really good book. If you are interested in health at all, this is a "must" read.

The 4 stars instead of 5 is because one major issue is avoided. Are health services a right or a privilege? Apparently the latter and that is the reality that allows lobbyists to influence, if not control, outcomes in Congress. The health issue touches us all. Access to care is often the difference between life and better health and death. Health care has been monetized to a degree that has made many who are in the health services business lose sight of the human element - you are your health and if you do not have access to fix health problems, nothing else matters very much..

Jonathan Bush, a Co-founder of Athenahealth (yes, that family) wrote Where does it Hurt?: An Entrepreneur's Guide to Fixing Healthcare. There is a part of one paragraph in the book that says it all: " . . . of the fifty thousand providers I work for, the vast majority are aching to do great and meaningful work. And they'd flock to a system that provided more opportunities for -- provided they didn't have to take a big pay cut."

When the lobbyists come out to play, follow the money. They are totally about jobs and profits and the status quo and their clients in pharmacy, insurance, and all kinds of health executives are becoming wealthy beyond their wildest dreams. The cost is damage to the American economy in so many ways, but more importantly, people die here because they cannot get care. Infant mortality in the inner cities rivals that of third world countries. If this was only about the lives of the poor and disadvantaged, the solutions would be easier; but this is about money and jobs and where that is #1, the lives of the poor and disadvantaged don't count. The House and Senate in Washington are us; the Congress reflects our values and how we view our obligations to our less fortunate brothers and sisters.

My last quibble is with Mr. Brill's solution, letting the foxes be the guardians. Docs running New York - Presbyterian argue that the hospital loses money on Medicare. As one who has spent nearly 40 years in the health services business, there is absolutely no doubt that those statements are simply not true. There is no way NY-Pres drops $500 million on the bottom line with a patient mix of 30% Medicare, 30% Medicaid and 40% Private pay unless there are profits from Medicare and the Medicaid losses are not all that great. You can't have the foxes guarding the henhouse fibbing and fudging. That will be little better than what exists today.

There are other fixes that are needed and Mr Brill identifies many. But, as noted by Jonathan Bush, about 65% of the "savings" and "waste" that could be wrung out of the health economy represents someones income. Cutting $100 billion cuts $65 billion of fees, salaries, and lots and lots of jobs. High paying jobs. The battles over health spending will be brutal.

This was our book group selection for June 14, 2015. Main thing we learn from it is that Obamacare does help cover people with limited means but the whole thing is designed to make the medical businesses more money. They would never have passed it otherwise. And they make so much money already! The real problem is the cost and the folks with the money are the ones that dictate the terms - so they would only agree if it insured they would get a bigger cut. So everyone that can pay has to pay more. There just seems no way the guy at the bottom wins - ever.

A great look at the insides of public politics. There more detail than I could really follow such as was who. But I got the book on Audible and that made the story some easier to follow. I hope will write a book about lobbying in general.

I enjoyed the March Time magazine article, I believe the article was in 2013. This book dives into a lot of political details that most don't care about or have time for. I like Steven Brill. It is well researched, but too much detail. I don't trust my government and I don't think the law was written in good faith or the well being of America. I believe the Republicans secretly supported it then and still do. This law has created windfalls for Health insurers, and hospitals, but not necessary doctors. Steven covers these things, but not really. Our world is controlled by evil people who do evil things for their own benefit for their own selfish greed. No where is it more pronounce and prevalent than in the US Health care systems. Doctors and Nurses try to do their best, and usually do, by MBAs with Hospital Admin degrees come in and soak up profits while providing little to no benefit, except to create more profits, so they can have more, more, more, more, and still more. I don't think Steven Brill hits on this last point hard enough in the book.

Interesting look inside the Health Care and Political systems, both of which are badly, and sadly broken. Brill goes deep into the ACA/ObamaCare (sad that a majority of Americans don't know they are the same thing) and looks at how and why we got to the current set up. I thought it was a balanced look at the evolution and current state-without a right/left/ conservative/liberal/tea party slanted approach, with ample opportunity to point the finger at whatever party or politic you disdain. But be careful, you'll get your share. I really enjoyed the first rollout of the on-line enrollment process and what a cluster-muck it was--with deep-dive into all the reasons for it, and what needed to be done to get it up and running, as well as all the back room deal making that takes place. There are a lot of very specific examples of physician, patients hospitals, insurers and health care systems and all the impacts that this legislation has, and my biggest take away is that until we put patient care and outcome in the middle and do EVERYTHING we can to take inefficiencies out of the system (both public AND private sector) we are a long way from fixing this mess.

Very well written and I formative with many notes and break downs of the whole Obamacare debacle. Brill does a brilliant job in investigation work to find all the sources and broken promises made by the administration for the reformed Healthcare law that simply did nothing for the people it was defined for.

Literally an awesome book to learn about the (potentially now changing) healthcare system. Potentially recommend reading a book about the system first for easier understanding or have some knowledge of how healthcare in the us works

Excellent and very detailed account of the ACA's passage. Full of details and insights.

Four stars not five due to the excessive amount of detail. I would have preferred 75 fewer pages, with many conversations summarized or omitted

Excellent review of the highly fragmented and dysfunctional US Health Care non-system. As most independent writers note; the for profit, investor owned insurance companies are the prime issue and impediment to Universal Health care at a reasonable cost.

Steven Brill has done the impossible: he has made the utterly mind-numbing subject of "Modern American Healthcare" actually understandable! From the early Blues (health insurance companies) in Texas to IRS decisions on "to tax health benefits or not?" (those meddling unions) to Nixoncare to Hillarycare to Romneycare to Obamacare...& all of that is before the 10% mark!

I have been looking for something to read that would give me the information of how did we get to this point anyway? I found it here. Even though this book is informative, it is not a textbook. The author weaves personal experiences in that illustrate his points profoundly. If you want to know what's going on, read this book.

Brill does an excellent job of educating the reader about how healthcare works in America. He also delivers the best chronology of how ACA came to be. Lastly, he provides insight into how America could right the SS Obamacare.

Never thought I would so thoroughly enjoy a book on health policy and legislative meandering. Easy to read and kept me involved, cover-to-cover. If you want to know why the A.C.A. is so convoluted and why health care is so expensive in the USA, this book will explain it in a simple, concise narrative with many relevant anecdotal examples.

A well-balanced discussion of the Affordable Care Act that all citizens should read. The book covers the background for and the sketchy initial implementation of the legislation, continues with current-day issues, and offers suggestions for next steps.