Overview

Written for nonexperts, this is a brisk, engaging history of American healthcare from the advent of Medicare and Medicaid in the 1960s to the impact of the Affordable Care Act in the 2010s. Step by step, Jonathan Engel shows how we arrived at our present convoluted situation, where generic drugs prices can jump 1,000 percent in a day and primary care physicians can lose 20 percent of their income at the stroke of a Congressional pen. Unaffordable covers, in a conversational style punctuated by apt examples, topics ranging from health insurance, pharmaceutical pricing, and physician training to health maintenance organizations and hospital networks. Along the way, Engel introduces approaches that other nations have taken in organizing and paying for healthcare and offers insights on ethical quandaries around end-of-life decisions, neonatal care, life-sustaining treatments, and the limits of our ability to define death. While describing the political origins of many of the federal and state laws that govern our healthcare system today, he never loses sight of the impact that healthcare delivery has on our wallets and on the balance sheets of hospitals, doctors' offices, government agencies, and private companies.

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Reviews

Engel's clear storyline and simple (but not simplistic) analysis make sense of a topic of mind-boggling complexity. Invaluable. - David Herzberg, author of Happy Pills in America A comprehensive, readable, balanced examination of the costs of the crazy quilt healthcare 'system' that has evolved in the United States over five decades. - Ronald L. Numbers, coeditor of Sickness and Health in America

Engel's clear storyline and simple (but not simplistic) analysis make sense of a topic of mind-boggling complexity. Invaluable. - David Herzberg, author of Happy Pills in America A comprehensive, readable, balanced examination of the costs of the crazy quilt healthcare 'system' that has evolved in the United States over five decades. - Ronald L. Numbers, coeditor of Sickness and Health in America Engel, author of four previous books on healthcare policy, presents a deeply researched, authoritative, and rigorous account of healthcare's flaws. . . . An important, concise appraisal of the current situation and of the way that America got here. -Foreword Reviews

Author Information

Jonathan Engel is the author of American Therapy; Poor People's Medicine; Doctors and Reformers; and The Epidemic: A History of AIDS. He is a professor in the School of Public Affairs at Baruch College and an adjunct professor of health policy and management at the Mailman School of Public Health, Columbia University.

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