Still Broken: Understanding the U.S. Health Care System

Still Broken: Understanding the U.S. Health Care System

Still Broken: Understanding the U.S. Health Care System

Still Broken: Understanding the U.S. Health Care System


The debate over health care policy in the U. S. did not end when President Obama signed the landmark Patient Protection and Affordable Care Act (PPACA) on March 23, 2010. Since then, half the states have sued and federal judges have issued conflicting rulings about the law's constitutionality. In addition, the new Republican-controlled House of Representatives voted to repeal it, and Republicans have pledged to bring it up again during negotiations over the 2012 federal budget.

The continuing controversies over PPACA are only one reason that Still Broken: Understanding the U. S. Health Care System is a must-read for engaged citizens, policymakers, students, and scholars alike. The book takes a close look at our problems, proposes solutions to them, and explains how to navigate our political system to effect positive change. It will help readers:

• Assess the arguments made by partisans on both sides of the continuing debate.

• Understand why President Obama was able to get Congress to pass a comprehensive reform bill even though most of his predecessors tried and failed.

• Understand why so many Americans are either confused about its value or actually oppose it.

In the book's first part, Stephen M. Davidson paints a lucid picture of the way that the health system works and the forces that produced the monumental problems that we face today. Then, he makes a compelling case for overhauling our system, offering six elements for inclusion in any plan for change. Davidson devotes the last three chapters to a detailed examination of the politics of reform. This assessment will help readers to appreciate both the political achievement represented by passage of the new law and the reasons that opposition to the law remains so widespread, despite all the good it does for the public. Whatever compromises, if any, are accepted by negotiators in the end, the book makes clear why, to fully solve the system's problems, the underlying goal must be to change incentives for all players who participate in the system and, finally, why this goal cannot be achieved by relying solely on market-based solutions. Davidson's captivating and persuasive book demonstrates that only a solution with a large public-sector role can lead us to real reform.


Following publication of the influential Flexner Report on medical education in 1910, the United States built on a foundation of science a health care system that, by the end of the 20th century, was the envy of the world. A visible symbol of that accomplishment is the astonishing number of health-related Nobel Prizes won by American physicians and other scientists. Since 1950, of the 133 prize winners in medicine and physiology, well over half have been either Americans or scientists who trained or worked in the United States.

Indeed, modern medicine is one of the unnamed wonders of the contemporary world. But it is more than a collection of impressive intellectual achievements. It has made a huge difference in the lives of many ordinary people in the United States and throughout the world. New treatments developed over the past one hundred years cure previously fatal acute illnesses. Even when the impact has not been to improve mortality rates, patients often recover much more quickly and with much less disruption of their daily lives and reduction of household income than in earlier times. Moreover, many chronic conditions that once were tantamount to a death sentence can now be managed effectively so that people who have them can carry on relatively normal lives.

It is no exaggeration to say that new drugs, new medical devices, and new surgical procedures have changed the face of illness to the point that we no longer need to fear many diseases that once evoked only the grimmest of images for the future. Following are some examples.

From the time of the Black Death, which is estimated to have killed onethird of the population of 14th-century Europe, until the advent of antibiotics, there was no good antidote to the effects of deadly microbes. Before . . .

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