Sep 25, 2020 in Book Review

Reinventing the American Healthcare

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The Affordable Care Act (ACA), which is also known as Obamacare, is one of the most significant law in the American political and healthcare spheres. It is so controversial that it has almost an equal number of proponents, who consider it a genius policy, and opponents who state that the ACA is an economic and political disaster. Among the people who have unlimited faith in ACA is Ezekiel Emanuel, the author of the book Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, and Error Prone System. Emanuel has written the book to inform and give an insider’s view of the ACA has been one of the policy advisers during the formation of ACA.

American Health System

The author has divided the book into three major areas, each of them geared towards making the reader grasp the American health system as it then was, is, or might be in the future. The first part serves as the justification for healthcare reform in the U.S. According to Emanuel, the U.S. healthcare system was not only broken but was also intensely expensive (Emanuel, 2014). It is the fact many seem to agree with, including both opponents and proponents of the ACA (Pipe, 2010, p. 15; Dawes, 2016, p. 3) Emanuel asserts that Americans were overpaying for mediocre healthcare services.

It seems to be the default argument of the book, a fact that some other experts in the area, like Pipes (2010), disagree arguing that in areas like cancer treatment, the U.S. has a higher survival rate than any country with universal healthcare services. Nevertheless, this set of affairs, according to Emanuel, conspired to have more than 15% of the American public uncovered.

The second part of the book provides the history of the attempted healthcare reforms in the U.S., from both the Democrats and the Republicans, most of which failed before the ACA starting from 1912. This section portrays universal healthcare as a lifelong dream of the American public. Emanuel (2014) explains that many of the ideas from the attempted reforms, and lessons from their failures both regarding policy-wise and politically, were taken into account by the political formulators of the ACA. Emanuel provides an example of the Massachusetts Universal Health Care Program initiated by Romney, the former state governor.

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Emanuel tries to predict the future of the American healthcare system in the third part of the book. Unlike many of the proponents of Obamacare, he does not defend or downplay the fiasco of the website. He attributes it to the fact that the administration of the website was not by a private information technology entity, but deal with this at the start of the third part (Emanuel, 2014). According to Emanuel (2014), the program will have more benefits than risks and drawbacks in the future. The author announces that ACA is more important in the long run than Social Security and Medicaid (Emanuel, 2014).

The Affordable Care Act (ACA)

The chief initiator and backer of the health insurance President Obama are considered to be one of the greatest American presidents. According to Emanuel (2014), the ACA will help to reach its purposes of improving healthcare quality in the U.S. and making the cost of healthcare services cheaper. For instance, he states that in some instances people cannot receive the insurer because they are too sick.

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As a book written on Obamacare, one would expect it to have a partisan approach that has bedeviled much of the literature on controversial issues in the country. Although Emanuel (2014) is a proponent of the ACA, he tries to avoid the political aspect when discussing the ACA and presents only facts. He states that Americans remained vulnerable even after they received health insurance.

For instance, more than 50% of Americans received their life insurance from their employers and a loss of their job would leave them uninsured (Emanuel, 2014). Furthermore, for some people, the issue was not even the affordability of health insurance, but access to it. He points out that more almost 10% of the uninsured homes had an annual income of more than $94,000 (Emanuel, 2014).

The author provides many details regarding the ACA in the book. For instance, he explains the reasons for the Act and why the clauses were important in the grand scheme of the law. In addition, Emanuel (2014) explores most of the federal health policies in the book. For instance, one can notice that there are two different changes for individuals and small businesses in health insurance. Moreover, the book is not voluminous. It is remarkable that the author managed to provide so much information in less than 400 pages.

Review of Weaknesses

However, even a book written by a brilliant academician like Ezekiel Emanuel has its weaknesses. Firstly, the book is overly-technical. While it is a strength for the academic class of readers, ordinary readers may find it difficult for comprehension. Moreover, the book contains some ungrounded predictions. For insurance, Emanuel (2014) predicts that insurance will as an industry change radically by 2025 with the advent of government-based websites.

Emanuel (2014) explains that the ACA will help in expanding coverage while reducing costs, but his prediction is not supported by facts and seems to be unrealistic. Most healthcare experts agree that an increase in coverage will lead to spiraling costs as more people choose cheaper insurance options (Pipe, 2010, 14). Overall, the book presents a very optimistic view of Obamacare.


Despite a few weaknesses in the book, Reinventing American Healthcare is one of the best works written about the ACA. While there are a number of researchers investigating the ACA, most of them provided no objective viewpoint on it. The book can be useful in a class and for future policymakers. The information provided in the book will not only give a deep insight into Obamacare but also discusses the history of the American healthcare system.

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