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Remedy and Reaction: The Peculiar American Struggle over Health Care Reform
In no other country has health care served as such a volatile flashpoint of ideological conflict. America has endured a century of rancorous debate on health insurance, and despite the passage of legislation in 2010, the battle is not yet over. This book is a history of how and why the United States became so stubbornly different in health care, presented by an expert with unsurpassed knowledge of the issues.
Tracing health-care reform from its beginnings to its current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap through policies that satisfied enough of the public and so enriched the health-care industry as to make the system difficult to change.
He reveals the inside story of the rise and fall of the Clinton health plan in the early 1990s--and of the Gingrich counterrevolution that followed. And he explains the curious tale of how Mitt Romney's reforms in Massachusetts became a model for Democrats and then follows both the passage of those reforms under Obama and the explosive reaction they elicited from conservatives. Writing concisely and with an even hand, the author offers exactly what is needed as the debate continues--a penetrating account of how health care became such treacherous terrain in American politics.
Tracing health-care reform from its beginnings to its current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap through policies that satisfied enough of the public and so enriched the health-care industry as to make the system difficult to change.
He reveals the inside story of the rise and fall of the Clinton health plan in the early 1990s--and of the Gingrich counterrevolution that followed. And he explains the curious tale of how Mitt Romney's reforms in Massachusetts became a model for Democrats and then follows both the passage of those reforms under Obama and the explosive reaction they elicited from conservatives. Writing concisely and with an even hand, the author offers exactly what is needed as the debate continues--a penetrating account of how health care became such treacherous terrain in American politics.
362 pages, Kindle Edition
First published May 31, 2011
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Displaying 1 - 26 of 26 reviews
August 20, 2018
I enjoyed the parts about the history of Health Care in the US - up through the Clinton Administration. It got more tedious after that and feels dated, as it was published in 2011.
March 20, 2019
A digestible account of the history of health care reform in the U.S. Starr breaks down the complexity of the ACA, all the actors, and the tenuous political climate before and after its passage. A great read.
January 1, 2012
To paraphrase Arthur Schlesinger Jr, “in a democracy politics is about something more than the struggle for power or the manipulation of an image. It is above all about the search for remedy.” Reform and Reaction is a history of the effort to find remedies that address the needs of the uninsured and underinsured as well as curtail the growth in healthcare expenditures.
Efforts to date on both objectives have fallen short. The US has extended coverage to a portion of the population--elderly, children, the indigent and veterans and a significant portion of the population has adequate health insurance from their employer. However, there are 45 to 50 million who don't fall into these groups. Moreover, the current system has not been able to contain costs.
This situation has resulted, according to Starr in a costly and complicated system that falls short of universal coverage but satisfies enough to thwart major change. (Starr describes this as the health policy trap.)
The portion of the book I found particularly informative was the section on the Affordable Care Act. Previous healthcare reform efforts failed in large part because the key players couldn't agree on a common course. Advocates in the Obama administration thought that an effort that was minimally invasive but still provided universal coverage would be successful. Starr points out how many of the key elements of the Affordable Care Act, such as the insurance exchanges, individual mandate and the lack of a "public option" were supported by Republicans in the 1990s and Obama thought that these features would attract at least some support from the opposition.
I recommend this book to anyone interested the policies, politics and history of healthcare reform in the US.
Efforts to date on both objectives have fallen short. The US has extended coverage to a portion of the population--elderly, children, the indigent and veterans and a significant portion of the population has adequate health insurance from their employer. However, there are 45 to 50 million who don't fall into these groups. Moreover, the current system has not been able to contain costs.
This situation has resulted, according to Starr in a costly and complicated system that falls short of universal coverage but satisfies enough to thwart major change. (Starr describes this as the health policy trap.)
The portion of the book I found particularly informative was the section on the Affordable Care Act. Previous healthcare reform efforts failed in large part because the key players couldn't agree on a common course. Advocates in the Obama administration thought that an effort that was minimally invasive but still provided universal coverage would be successful. Starr points out how many of the key elements of the Affordable Care Act, such as the insurance exchanges, individual mandate and the lack of a "public option" were supported by Republicans in the 1990s and Obama thought that these features would attract at least some support from the opposition.
I recommend this book to anyone interested the policies, politics and history of healthcare reform in the US.
February 27, 2012
This is a very accessible history of health care reform. Starr wrote a Pulitzer-winning history of American medicine and was an insider who helped shape Clinton's health care plan. He gives a brief history of how America's piecemeal approach to health care has led to the overly complex and sometimes ineffective system we have now, and how both Democratic and Republican attempts to overhaul it have run aground due to its complexity and Americans who are just satisfied enough with their coverage to fear comprehensive reform. Although I think the whole book is worthwhile, the first chapter is a good overview of how we got the health care system we have, and Chapter 8 clearly lays out the changes brought about by Obama's Affordable Care Act. I'd recommend this along with T. R. Reid's The Healing of America, which explores how health care works in other countries.
June 17, 2025
Starr gives a thorough history of not only health care reform but general market-trends in United States health care, beginning around the early 1900s until 2013. Of course, the book is out of date, but all books on reform eventually will be.
I originally read the book to learn more about health care, as I am losing my insurance this year. Not only does he cover nearly a dozen terms ("managed care," "HMO," "PPO," "fee-for-service," etc.), but he highlights how the employer-insurance system operates and how it is subsidized.
The book also tells a surprisingly honest story of the corruption within health care reform coming from both parties in response to the pharmaceutical industry, hospitals, doctors, and of course the private insurance lobbies. The book could be best summarized with a few pillars: the US diverged early on from European countries and failed to implement single-payer, no president until Bill Clinton seriously pushed for massive reform, interest groups (including unions) often opposed reform efforts or accepted minimal reform as a compromise to public pressure, people already covered by government insurance were unwilling to risk or support any changes, and Obama pandered to a right-wing that was unwilling to negotiate in Congress or in the courts.
The book is also surprisingly skeptical of Obamacare, and this has aged well. The author does not specifically endorse any particular policy, acknowledging they all have tradeoffs, including single-payer's lack of political capital at the time. It would be fascinating to see if his analysis has changed since. Highly recommend for someone interested in political theory (policy traps, economic incentives, capitalism vs. socialism, etc.) as well as someone who wants to learn more about the convoluted US health care system without reading a bunch of legalese.
I originally read the book to learn more about health care, as I am losing my insurance this year. Not only does he cover nearly a dozen terms ("managed care," "HMO," "PPO," "fee-for-service," etc.), but he highlights how the employer-insurance system operates and how it is subsidized.
The book also tells a surprisingly honest story of the corruption within health care reform coming from both parties in response to the pharmaceutical industry, hospitals, doctors, and of course the private insurance lobbies. The book could be best summarized with a few pillars: the US diverged early on from European countries and failed to implement single-payer, no president until Bill Clinton seriously pushed for massive reform, interest groups (including unions) often opposed reform efforts or accepted minimal reform as a compromise to public pressure, people already covered by government insurance were unwilling to risk or support any changes, and Obama pandered to a right-wing that was unwilling to negotiate in Congress or in the courts.
The book is also surprisingly skeptical of Obamacare, and this has aged well. The author does not specifically endorse any particular policy, acknowledging they all have tradeoffs, including single-payer's lack of political capital at the time. It would be fascinating to see if his analysis has changed since. Highly recommend for someone interested in political theory (policy traps, economic incentives, capitalism vs. socialism, etc.) as well as someone who wants to learn more about the convoluted US health care system without reading a bunch of legalese.
May 28, 2018
“When America finally adopted critical tax and health-financing policies in the two decades after World War II, it ensnared itself in a policy trap, devising an increasingly costly and complicated system that has satisfied enough of the public and so enriched the health-care industry as to make change extraordinarily difficult.”
Follow-up to Social Transformation, this is astute analysis of healthcare policy from the 1980's-2010.
Follow-up to Social Transformation, this is astute analysis of healthcare policy from the 1980's-2010.
October 7, 2019
An excellent read for those wondering how America's system of health care (really, non-care for too many) came to be. Fair warning: it will make your blood boil. It goes into the various attempts at providing universal healthcare, the steps forward, the problems and the steps back. Starr was a key part of helping with the effort of former President Clinton to overhaul the healthcare system, so there's a bit of a slant. Still, there's lot of information here, it's definitely worth checking out.
February 25, 2018
Provided a good, thorough insider perspective of the development and failure of the Clinton health plan and the subsequent developments leading to the passage of the ACA but could use a tighter focus and now needs to be updated to take into account the implementation of the exchanges and the aftermath of the 2016 election. Sadly, the battle over healthcare reform appears to be unending.
February 20, 2018
I used this book in a Health Policy and Politics course. We read only a few sections of this book for the course; however, what we read I really enjoyed. I felt that it gave life and a personal touch to what could be a dry topic.
April 26, 2018
A masterclass. This book is both a solid history of America's health care struggle over the years and a useful guide to indicate where we might be heading. Paul Starr has produced an informative and enjoyable work in Remedy and Reaction. I highly recommend it!
December 6, 2020
A surprisingly engaging account of the political side of healthcare reform over the past century. If you are interested in reading substantive information rather than divisive, ideological rhetoric about the issue, this book is a great start.
April 3, 2020
I wrote a more in depth analysis you can read here:
http://taylorandrewbrown.com/book-rev...
http://taylorandrewbrown.com/book-rev...
October 14, 2023
Hard to read but interesting
November 21, 2012
A tremendously boring procedural book on healthcare legislation history. The author walks a narrow, dull line between characterizing and examining the players and exploring the ramifications of the new law. It's notable for neither and is overly simplistic, with a liberal slant that is not well masked nor justified by the content.
Adding a bit more since I'm off the plane.
Specifically, Starr sees the passage of the legislation as an achievement in and of itself. He's less concerned with the issue of whether the legislation will work than he is tooting a bugle for the triumph of Obama. For example, in his concluding chapter, he talks about the ideal of universal coverage as achieved through Obamacare, when only pages before he mentioned that the rising costs of care will go largely unchecked by this legislation, and that coverage that does not contain costs will be unsustainable very quickly. The lack of real substance became apparent when he mentioned litigation reform as a cost containment measure exactly once, despite legal insurance costing as much as 36% of operating costs for physicians (and that's just physicians I know personally).
Starr seems to be more interested in the politics of healthcare than the administration. He cites precious little that seems to indicate that he is intimately aware of the business facts of healthcare and insurance. He proceeds from vagaries like "insurance and hospitals have been enriched by Medicare" to arguments like "insurance companies cherry-pick constituents and underwriters decide your fate from on high". This displays a troublesome simplification of what insurance does and how it works. One of his closing points is "the sick have been the victims of insurance companies that stack the odds against them." As if some certain arrangement of payors and patients will solve the problem of sick patients costing substantially more money to insure and treat. In fact, that premise pervades this book, that if somehow we legislate strictly enough so that insurance covers everyone at the same prices, we will have won. Won what is unclear. Every arrangement he cites has the problem of "adverse selection", but to him that doesn't seem to indicate that there is a systemic cost problem in covering the sick population, only that we haven't found strict enough legislation or generous-enough subsidies.
He should know better. In his analysis, he treats the government as some charity with deep pockets that only needs to decide how much to subsidize care. He doesn't talk much about deficit ramifications or sustained viability, accepting only the administration's projections of 1% above current spending. He barely talks about tax ramifications. While he'll talk about the healthy subsidizing the sick through insurance and hospital costs, he seems to have glossed over the idea that government subsidy will be yet another factor redistributing money to the ill at the expense of others who won't benefit from the tax they pay. This all amounts to a major flaw-that the book is written without sufficient context.
It did have interesting analysis and history on such programs as Medicare, Medicaid, and CHIP. And for people that don't know what's in Obamacare, this would make an okay overview (though not a really objective one.)
Adding a bit more since I'm off the plane.
Specifically, Starr sees the passage of the legislation as an achievement in and of itself. He's less concerned with the issue of whether the legislation will work than he is tooting a bugle for the triumph of Obama. For example, in his concluding chapter, he talks about the ideal of universal coverage as achieved through Obamacare, when only pages before he mentioned that the rising costs of care will go largely unchecked by this legislation, and that coverage that does not contain costs will be unsustainable very quickly. The lack of real substance became apparent when he mentioned litigation reform as a cost containment measure exactly once, despite legal insurance costing as much as 36% of operating costs for physicians (and that's just physicians I know personally).
Starr seems to be more interested in the politics of healthcare than the administration. He cites precious little that seems to indicate that he is intimately aware of the business facts of healthcare and insurance. He proceeds from vagaries like "insurance and hospitals have been enriched by Medicare" to arguments like "insurance companies cherry-pick constituents and underwriters decide your fate from on high". This displays a troublesome simplification of what insurance does and how it works. One of his closing points is "the sick have been the victims of insurance companies that stack the odds against them." As if some certain arrangement of payors and patients will solve the problem of sick patients costing substantially more money to insure and treat. In fact, that premise pervades this book, that if somehow we legislate strictly enough so that insurance covers everyone at the same prices, we will have won. Won what is unclear. Every arrangement he cites has the problem of "adverse selection", but to him that doesn't seem to indicate that there is a systemic cost problem in covering the sick population, only that we haven't found strict enough legislation or generous-enough subsidies.
He should know better. In his analysis, he treats the government as some charity with deep pockets that only needs to decide how much to subsidize care. He doesn't talk much about deficit ramifications or sustained viability, accepting only the administration's projections of 1% above current spending. He barely talks about tax ramifications. While he'll talk about the healthy subsidizing the sick through insurance and hospital costs, he seems to have glossed over the idea that government subsidy will be yet another factor redistributing money to the ill at the expense of others who won't benefit from the tax they pay. This all amounts to a major flaw-that the book is written without sufficient context.
It did have interesting analysis and history on such programs as Medicare, Medicaid, and CHIP. And for people that don't know what's in Obamacare, this would make an okay overview (though not a really objective one.)
April 12, 2012
I've fallen in love with Paul Starr's mind! He's written a superb history of the politics of health care in America. I'll admit that it took a couple of weeks to get through, but that's because I got a little exercized at the notion that the U.S. alone of all the G20 countries, fails to provide for the health of all its citizens. Nothing I didn't know, but seeing the timeline of inequality laid out, complete with the well-meaning proponents being struck down at every turn... 'Nuff said.
The culmination of course is the passage of the Affordable Care Act. Starr, though, published too early to report the results of the current Supreme Court deliberations. Unfortunate.
Starr is an accomplished scholar who has made a complex issue accessible to educated people.
The culmination of course is the passage of the Affordable Care Act. Starr, though, published too early to report the results of the current Supreme Court deliberations. Unfortunate.
Starr is an accomplished scholar who has made a complex issue accessible to educated people.
July 12, 2012
An extremely thorough history of America's failed attempts at providing health care for citizens. Even the ACA turns out to have been crafted by too many giveaways. Starr is very good at explaining the opposition's concerns that having government provide coverage results in "a loss of freedom". He is less good at explaining why getting a subsidized service you didn't have, probably couldn't afford and will certainly need is seen as a loss of freedom.
October 22, 2015
Play by play policy cum history leading to Obamacare/ACA. Informative but too interested in inside baseball in Congress and the White House. More explanation of some of the unerlying law and economics would have been helpful. Generally good. Starr's earliy book (Social Transformation of American Medicine) was way better.
Read
June 15, 2013Not exactly a page turner but I was glad to have some solid facts about health care reform in the USA. I also read his Social History of Medicine which was just as informative and dry. Did a lot of skimming in both books.
December 12, 2011
Essential reading if you want to understand how we got to where we are when it comes to healthcare reform.
September 2, 2015
The first half read like a dry textbook, but this book is worth it for the analysis of ACA philosophy alone. Certainly a useful tool to actually be informed in health care debates!
July 15, 2012
Excellent review of the politics of healthcare reform from Pre-Clinton on to 2010.
July 28, 2012
Fascinating book about the history of healthcare reform. Really makes you realize the complexities of the system and how we got here.
December 19, 2014
Much emphasis on history and less on the actual reform. If you're looking for the latter, I suggest Jon McDonough's treatise on the subject.
December 15, 2012
Easily digestible chronicle of healthcare policy and politics in the US. Left me wanting for more detail in places, so you might say it's a victim of its own success.
April 23, 2014
Excellent historical overview of America's healthcare predicament and the future hope that the Affordable Care Act has instituted.Well worth reading. Paul Starr never disappoints. Good work.
November 4, 2012
Awesome. A good synopsis of where we are at in healthcare reform and how we got here.
Displaying 1 - 26 of 26 reviews