HEALTHCARE USA

An economist offers an exhaustive condemnation of the American health care system in this nonfiction book.

With more than four decades of experience in health and retirement benefit plans, Schieber has an in-depth understanding of health care in America. In this voluminous, painstakingly researched work, he provides a historical perspective and current evaluation of the inner workings of the health care system, drawing on his own original explorations and other sources. His negative perspective is obvious: Part 1 is titled “Healthcare USA: A Cancer on the American Dream,” and Part 2 addresses “The Healthcare Provider Market and Exploitation of the Vulnerable.” In both parts, Schieber methodically dissects American health care, peppering readers with a dizzying array of facts and a wealth of statistical tables to support his argument. Part 1 examines health care in light of economic conditions from the 1980s through the 2010s. The controversial and highly politicized Affordable Care Act of 2010, aka Obamacare, does not escape the author’s critical eye. Schieber writes that while it did “improve access to care for many lower-income individuals and families,” the ACA “has provided little relief from excessive health care costs for people with employer-sponsored health insurance.” Part 2 delivers a bleak assessment of America’s health care costs at the provider level, taking into consideration hospitals, physicians, and pharmaceuticals. Schieber is at his best when referring to specific examples, such as his analysis of the development and pricing of insulin. In this part, the author notes that higher health costs are the result of more than just pricing issues; rather, he writes, they involve “widespread failure by almost every component” of the “health-industrial complex.” In Part 3, Schieber cites a 1975 study to dramatize the fact that the American health care system has basically not improved much since then. He recounts encouraging examples, such as Maryland’s testing of an alternative all-payer health program over five decades, as well as systems like Kaiser Permanente that are attempting to control costs. Still, it seems the primary purpose of this absorbing book is to indict American health care rather than propose specific solutions.

An engrossing, scholarly study that paints a sobering health care picture.