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Book Review

‘Reinventing American Health Care’ by Ezekiel Emanuel

An insider looks at the Affordable Care Act

Ezekiel Emanuel, former senior health adviser to President Obama, is one of the Affordable Care Act’s architects.

Ezekiel Emanuel, former senior health adviser to President Obama, is one of the Affordable Care Act’s architects.

Like it or not, the Affordable Care Act is probably here to stay. But you really should like it, according to Ezekiel Emanuel, former senior health adviser to President Obama and one of the measure’s architects. He describes the program, often referred to as Obamacare, as “a world historical achievement, even more important for the United States than Social Security and Medicare have been.”

Infused with diagrams, charts, and tables, this book is informative, thought-provoking, and immensely important. Given his role in the program, and as is reflected in the subtitle of the book, Emanuel clearly wants to persuade, but he also wants to explain. And because he was an insider — and proves himself a gifted writer — he makes an able guide to the complexities of the landmark legislation.

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The first third of the book outlines in vivid and unsparing detail just how necessary it was to fix the broken American health care system. Prior to the enactment of the law in 2010, the nation’s health care was not only the most expensive in the world but also provided most Americans with decidedly mediocre care and left almost one-sixth of the population without reliable access to services.

The next third describes the many attempts over the last century — from both sides of the political divide — to reform health care in the nation. Emanuel shows how many of these ideas were subsequently incorporated into the final plan: Romneycare in Massachusetts is only one example of this.

The final portion is titled “The Future of American Health Care.’’ Although clearly a proponent of the program, Emanuel begins by excoriating the flawed rollout of healthcare.gov in October of last year and then moves on to detail what he believes the long-term benefits of Obamacare will be in the years to come — assuming, of course, that it can recover sufficiently from that fiasco and attract enough relatively healthy enrollees to survive.

This section is perhaps the most fascinating, as it reveals just how boldly ambitious the act is. As Emanuel makes clear, the ultimate purpose is to broaden access to health care in this country, improve its quality, and decrease its overall cost by radically changing the system.

However, it is still far from clear that these goals will be met. In the meanwhile, health care providers and organizations struggle to keep up with its requirements, some which can seem almost Orwellian.

Many physicians, for example, feel that by being forced through the multiple steps of documentation necessary to demonstrate “meaningful use” of the electronic medical record with each patient encounter — one of the quality measures of the law — they actually have less time to spend with their patients.

Shorter visits and poorer communication between doctors and patients, in turn, can lead to more expensive care and worse outcomes. This and other ground-level problems with Obamacare receive less attention in the book than they would seem to merit, though Emanuel clearly recognizes that the program is far from perfect, and doesn’t hesitate to point this out.

Clearly, if Obamacare is to fulfill its promise there will need to be significant changes and that will require collaboration among citizens, health care professionals, scholars, and lawmakers from across the political spectrum. And the only way this can happen is if people understand what exactly is at stake. “Reinventing American Health Care’’ spells this out clearly, and by doing so, lays the foundation for this kind of collaboration to occur.

Dennis Rosen is a pediatric pulmonologist who practices in Boston. His book “Vital Conversations: Improving Communication between Doctors and Patients’’ will be published this summer.
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