I’m up to page 220 (of 512 pages) in America’s Bitter Pill, Steven Brill’s new book about the U.S. health care system, and I’ve pored through the index and looked hard at the recommendations at the end.
So far, my verdict is that the book is a great, useful book. Whether you agree or disagree with Brill’s perspective on health reform and the Patient Protection and Affordable Care Act (PPACA), he’s done a great job of making sense of the drafting, passage and implementation of PPACA.
Someone could quibble about some of the omissions. It might be nice, for example, if he’d looked a little at health reform controversies in countries outside the United States, and if he’d looked at the performance of state-based exchanges other than Kentucky’s Kynect system.
He (sigh) does not mention me or LifeHealthPro.com. Of more significance: He doesn’t mention the National Association of Health Underwriters or the National Association of Insurance and Financial Advisors, and the surname “Trautwein” does not seem to be anywhere in the index.
But Brill does give a lot of great information about how the PPACA exchanges operated by the U.S. Department of Health and Human Services (HHS) came to be how they are.
He does mention everything from the tanning bed tax, to the essential health benefits package, to controversies over the exact nature of the preventive benefits package that every PPACA-compliant major medical plan must cover without imposing out-of-pocket costs on the enrollees.
He describes the infighting that led to many of the typos and other drafting problems in PPACA, and why the demotion of the “Office of Consumer Information and Insurance Oversight” to a “Center for Consumer Information and Insurance Oversight” (CCIIO) was a disaster for PPACA exchange program implementation.
He gives a plausible explanation of why the Obama administration shut out the advice of health insurance companies and health insurance brokers, even when they desperately needed technical advice from people in the health insurance industry – although, interestingly, it seems as if the people who gave Brill interviews are more likely to be the good guys than the folks who declined to be interviewed are.