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Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All (Publicaffairs Reports) Review
I'm a family physician that has followed the healthcare reform debate closely, dating well back into the Democratic primary season when Hillary and Obama were duking it out, dating even as far back as the failed Bill and Hillary Clinton first attempt during Bill Clinton's presidency. I found Landmark: The Inside Story of America's New Health Care Law to give a much richer historical perspective, and to give a much better analysis of the actual impact that the bill is likely to have, than was available from the fragmented and sensational mainstream media coverage.The book is a collection of essays written by Washington Post reporters, followed by the actual text of the bill. The essays in the book are far more analytical and informative than what was typically available throughout the somewhat histrionic coverage of Republican and Democratic maneuvering to respectively block or pass the eventual bill. One could have been left with the impression, when it was all over but the shouting, that the resulting bill was weakened to the point of being inconsequential from the point of view of reform, and enormous regarding eventual cost. Read Landmark, and you'll have a different opinion on both those points.
What was useful in the book? The many failed historical efforts to provide some form of national healthcare coverage go back over 100 years, a battle that until this last month stymied many presidents (including Teddy Roosevelt). The historical review alone made the book a worthwhile read for me. Secondly, the authors make a convincing case that, much in contrast to the typical media coverage, this bill represents a deep and broad change in the American approach to healthcare for its citizens, far more so than the Medicare and Medicaid legislation. After reading the essays, and even more powerfully after reading the actual legislation, I'm convinced that the authors are correct. Why? Though it is true that the bill is corrupted in places by special interests, and weakened by the deletions forced by political compromise, it also becomes clear that through a combination of fiat and incentive the new healthcare law will, for better or for worse, markedly change the way doctors/providers do business, and how their patients/clients experience their healthcare.
Fiats? No exclusion for pre-existing conditions, no excisions from insurance because you actually USE what you've purchased, no lifetime limits on coverage just because you actually got sick. Incentives? Buried in the legislation itself is a long list of encouragements to do what amounts to serious R & D (research and development) in methods to improve American health, and to treat American illness. In a country where 85% of health related research is done by notoriously biased private industry (the reverse of the ratio in Europe), creating conditions more amenable to less biased scientific research is a welcome and little discussed part of bill. Creating incentives for physicians/providers to focus on quality will change what you experience when you go in for healthcare, and this book details what you will be seeing change over the next few years.
As a socially liberal, financially conservative physician (voted for Reagan, actually went to his inaugural parade) my bottom line about Landmark is this: whether you love or hate the bill, your perspective on it will be different, and better balanced, when you are done reading it. Your ability to discuss the bill accurately will be significantly enhanced, as I've already found out on multiple occasions when confronted with nonsense statements from both the left and the right. If you wish to consider yourself informed on the Healthcare Reform Bill, this book will go a long way to getting you there.
Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All (Publicaffairs Reports) Overview
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