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America's Bitter Pill : Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System
by Steven Brill and Dan Woren

Overview - NEW YORK TIMES BESTSELLER
  • A NEW YORK TIMES NOTABLE BOOK • America's Bitter Pill is Steven Brill's acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry.  Read more...


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    More About America's Bitter Pill by Steven Brill; Dan Woren
     
     
     
    Overview

    NEW YORK TIMES BESTSELLER

  • A NEW YORK TIMES NOTABLE BOOK • America's Bitter Pill is Steven Brill's acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry. It's a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America's largest, most dysfunctional industry. It's a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time magazine cover story continues, despite Obamacare. And it is the first complete, inside account of how President Obama persevered to push through the law, but then failed to deal with the staff incompetence and turf wars that crippled its implementation.

    But by chance America's Bitter Pill ends up being much more—because as Brill was completing this book, he had to undergo urgent open-heart surgery. Thus, this also becomes the story of how one patient who thinks he knows everything about healthcare "policy" rethinks it from a hospital gurney—and combines that insight with his brilliant reporting. The result: a surprising new vision of how we can fix American healthcare so that it stops draining the bank accounts of our families and our businesses, and the federal treasury.

    Praise for America's Bitter Pill

    "A tour de force . . . a comprehensive and suitably furious guide to the political landscape of American healthcare . . . persuasive, shocking."The New York Times

    "An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Brill] has pulled off something extraordinary."—The New York Times Book Review

    "A thunderous indictment of what Brill refers to as the 'toxicity of our profiteer-dominated healthcare system.' "Los Angeles Times

    "A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform."The Daily Beast

    "One of the most important books of our time."—Walter Isaacson

    "Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system."The New York Review of Books
    From the Hardcover edition.

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    Details
    • Publisher: Penguin Random House Audio Publishing Gr
    • Date: Jan 2015
     
    Excerpts

    From the cover
    Chapter 1
    Looking Up from the Gurney

    I usually keep myself out of the stories I write, but the only way to tell this one is to start with the dream I had on the night of April 3, 2014.
    Actually, I should start with the three hours before the dream, when I tried to fall asleep but couldn't because of what I thought was my exploding heart.
    THUMP. THUMP. THUMP. If I lay on my stomach it seemed to be pushing down through the mattress. If I turned over, it seemed to want to burst out of my chest.
    When I pushed the button for the nurse, she told me there was nothing wrong. She even showed me how to read the screen of the machine monitoring my heart so I could see for myself that all was normal. But she said she understood. A lot of patients in my situation imagined something was going haywire with their hearts when it wasn't. Everything was fine, she promised, and then gave me a sedative.
    All might have looked normal on that monitor, but there was nothing fine about my heart. It had a time bomb appended to it. It could explode at any moment—-tonight or three years from tonight—-and kill me almost instantly. No heart attack. No stroke. I'd just be gone, having bled to death.
    That's what had brought me to the fourth—floor cardiac surgery unit at New York–-Presbyterian Hospital. The next morning I was having open—heart surgery to fix something called an aortic aneurysm.
    It's a condition I had never heard of until a week before, when a routine checkup by my extraordinarily careful doctor had found it.
    And that's when everything changed.
    Until then, my family and I had enjoyed great health. I hadn't missed a day of work for illness in years. Instead, my view of the world of healthcare was pretty much centered on a special issue I had written for Time magazine a year before about the astronomical cost of care in the United States and the dysfunctions and abuses in our system that generated and protected those high prices.
    For me, an MRI had been a symbol of profligate American
    healthcare—-a high—tech profit machine that had become a bonanza for manufacturers such as General Electric and Siemens and for the hospitals and doctors who billed billions to patients for MRIs they might not have needed.
    But now the MRI was the miraculous lifesaver that had found and taken a crystal clear picture of the bomb hiding in my chest. Now a surgeon was going to use that MRI blueprint to save my life.
    Because of the reporting I had done for the Time article, until a week before, I had been like Dustin Hoffman's savant character in Rain Man—-able and eager to recite all varieties of stats on how screwed up and avaricious the American healthcare system was.
    We spend $17 billion a year on artificial knees and hips, which is 55 percent more than Hollywood takes in at the box office.
    America's total healthcare bill for 2014 is $3 trillion. That's more than the next ten biggest spenders combined: Japan, Germany, France, China, the United Kingdom, Italy, Canada, Brazil, Spain, and Australia. All that extra money produces no better, and in many cases worse, results.
    There are 31.5 MRI machines per million people in the United States but just 5.9 per million in England.
    Another favorite: We spend $85.9 billion trying to treat back pain, which is as much as we spend on all of the country's state, city, county, and town police forces. And experts say that as much as half of that is unnecessary.
    We've created a system with 1.5 million people working in the health insurance industry but with barely half as many doctors providing the actual care. And most do not ride the healthcare gravy train the way hospital...

     
    Reviews

    Advance praise for America's Bitter Pill

    "A landmark study, filled with brilliant reporting and insights, that shows how government really works--or fails to work."--Bob Woodward

    "America's Bitter Pill is deeply impressive, an important diagnosis of what America needs to know if we're ever to develop a healthcare system that is fair, efficient, and effective."--Tom Brokaw

    "This is one of the most important books of our time. Through revealing personal stories, dogged political reporting, and clear analysis, it makes the battle over Obama's healthcare plan come alive and shows why it matters. It should be required reading for anyone who cares about our healthcare system."--Walter Isaacson

    "In America's Bitter Pill, Steven Brill brilliantly ties together not only the saga of Obamacare, but also the larger story of our dysfunctional healthcare system and its disastrous impact on both businesses and ordinary Americans. In a gripping narrative, his thorough reporting is made all the more powerful by his own scary experience looking up from a gurney." - Arianna Huffington

     
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