Health Care Reform: What It Is, Why It's Necessary, How It Works

Jonathan Gruber is an MIT economist and principle architect of Massachusettscare, and was a consultant with the Obama administration and Congress during development of the Affordable Care Act. His book, with H.P. Newquist, is an educational comic book that tells us "what" the ACA is, "why" it's necessary, and "how" it works. It is actually a fast and fun read with a bunch of easy to understand factoids.We first learn almost half of our "private" health care system is already paid by the government, with a lesser amount paid by consumers/employers. Back in 1950 only 5% of our earnings went for health care; we now pay over 17% for care. But Gruber tells us we don't want 1950s medicine where 29 of 1000 infants died in the first year versus 7 today, and 6 out of 1000 adults died of a heart attack versus half that today.Regarding wasted and expensive care, we are told that each Medicare enrollee in McAllen, Texas cost the system $15,000, twice the cost in El Paso for patient outcomes that are no better. Another example is Camden, New Jersey where 1% of the population accounts for more than 30% of the city's health expenses.The Massachusetts care solution was to get everyone covered so the insurance companies could price the insurance fairly knowing they were getting the average risk. This was the individual mandate that provided subsidies for coverage that included preexisting conditions.Under the ACA insurance will need to cover a standard set of services for doctors, hospitals, drugs, and mental health, where total out-of-pocket expenses cannot exceed $6000 per year. Families will pay as little as 2% of their income and no more than 9.5% to buy the insurance. Because the ACA is so expensive ($940 billion over 10 years), the government will cut overpayments to private insurance companies, tax the profitable drug, device, and insurance companies, and individuals earning more than $200,000, and put a surcharge on the "Cadillac policies" that drive up medical costs with overly generous benefits using tax-free money.The goals of the ACA are to lower individual health care costs and reduce costs to the government. Maybe it is worth the wait to see if something good happens.

I haven't read this 65-page essay in comic book format since it first was published a couple of years ago. Nonetheless, it was so easy to understand I think I have retained the basics.First, there's no polemics here, just the facts, starting with the stark truth that more of the same is an Rx for disaster. Gruber provides the unassailable statistics that runaway health care costs are the primary driver of our national budgetary crisis, and compares our national health care expenditures as a % of GDP to that of the European democracies. Then he outlines the fundamental purposes of the ACA, including (a) expanding coverage for more Americans, (b) increasing the quality of treatment for all Americans and (c) bending our national healthcare cost curve. He explains how addressing the first two purposes helps accomplish the third. This includes explaining the economic and human benefits of funding preventive medicine and also how the promise of expanded markets wooed the healthcare insurance industry into accepting a restriction on the % of their gross revenues that healthcare companies could use for general & administrative expenses; depending on volume, now providers can apply only 15-18% on G&A, as opposed to pre-ACA, many health corporations were consuming up to 35% for G&A (meaning top-heavy salaries). Now, all receipts over those caps must fund direct health-care treatments and expenses. This alone is projected to account for a 10-15% reduction in national health expense.The ACA also mandates best treatment practices agreed upon by the leading health centers in the country (e.g. Mass Gen, Gisenger & Mayo Clinic). No longer will the federal government pay for unwarranted and redundant tests and procedures. Now computerized reports track and penalize doctors who don't follow the state-of-the-art protocols and the ACA rewards financially doctors who achieve greater positive treatment outcomes. That would seem not only to be better for people, but it should result in lower treatment costs, as well.I am far away from my own area of expertise. Maybe that's why this little comic book was meaningful to me. It pulled open the curtain hiding the wizards profiting in many cases from our unnecessary anguish.

For anyone who wants a very quick and general overview of the components of the ACA, this is a great place to start. I read it in about 45 minutes, and now plan to start in on some other books that provide a much more in-depth view.For those of you who are in the categories of businessman or businesswoman, right of center, or making over $200,000 per year, you will need to overlook Professor Gruber's and his illustrator's unfortunate tendancy to depict you as an angry, heartless, ignorant, and reactionary dunderhead. I happen to be a Republican who cares about the poor, is willing to contribute more to help people with their healthcare, and am quite well informed. While I was occasionally offended by Professor Gruber's stereotypical view of me and my cohorts, I was not surprised by it and will still recommend the book. But Professor Gruber, just a little advice for your next book. Not everyone on my side of the aisle worships Rush Limbaugh and wants to keep all of their money to themselves. If you want to convince me of the rightness of your opinion, demonizing me in the process is not a good strategy. And I would say the same to the Paul Ryans, Mitch McConnells, and John Boehners of the world...