Synopses & Reviews
The Affordable Care Act will have a dangerous effect on the American economy. That may sound like a political stance, but itandrsquo;s a conclusion directly borne out by economic forecasts.and#160; In Side Effects and Complications
, preeminent labor economist Casey B. Mulligan brings to light the dire economic realities that have been lost in the ideological debate over the ACA, and he offers an eye-opening, accessible look at the price American citizens will pay because of it.
Looking specifically at the labor market, Mulligan reveals how the costs of health care under the ACA actually create implicit taxes on individuals, and how increased costs to employers will be passed on to their employees. Mulligan shows how, as a result, millions of workers will find themselves in a situation in which full-time work, adjusted for the expense of health care, will actually pay less than part-time work or even not working at all. Analyzing the incentivesandmdash;or lack thereofandmdash;for people to earn more by working more, Mulligan offers projections on how many hours people will work and how productively they will work, as well as how much they will spend in general. Using the powerful tools of economics, he then illustrates the detrimental consequences on overall employment in the near future.
Drawing on extensive knowledge of the labor market and the economic theories at its foundation, Side Effects and Complications offers a crucial wake-up call about the risks the ACA poses for the economy. Plainly laying out the true costs of the ACA, Mulliganandrsquo;s grounded and thorough predictions are something that workers and policy makers cannot afford to ignore.
"Bradley, faculty director of Yale University's Global Health Leadership Institute, and Taylor, the institute's former program manager, contrast American healthcare models with the much more successful models in Denmark, Norway, and Sweden. The Scandinavian model, a dramatically more holistic approach envisioning citizen health as inextricably linked to national welfare, views greater spending on housing, education, employment, and nutrition as necessary components of healthcare outcomes, resulting in less overall spending with far greater results. The authors assemble an expansive study of representatives from the health-care and social sectors, including hospital administrators, social workers, physicians, police, emergency service personnel, nurses, educators, and pharmacists to demonstrate the need for integration between medicine and social welfare in the U.S. The disconnect between social services and health care, and the deeper historical schism between public and private interests, emerges as the reason why the U.S., which ranks first in healthcare spending, is mired in disappointing health outcomes. Admirably presented as an apolitical examination of an urgent situation, Bradley and Taylor's carefully researched and lucidly reported findings, including innovative approaches in Connecticut, Oregon, and California, offer what appears to be an easily rendered fix, but their equally striking depiction of uniquely American hostility to government involvement in private matters, exposes a daunting uphill battle." Publishers Weekly Copyright PWxyz, LLC. All rights reserved.
and#147;The American Health Care Paradox
and#8221; has enough intellectual heft to bring an opera house to its feet. Drawing on data from dozens of international and domestic site visits, wide-ranging scholarly studies and in-depth interviews with patients, practitioners, health care administrators and social service staff from all over the world, the authors tackle the unenviable task of explaining why we think of health care the way we doand#151;to the near total exclusion of social services. And they manage to do it with astonishing clarity, conciseness and narrative ease.and#8221;and#151;Pauline Chen, the New York Times
and#147;An important attempt to shift the discussion on health in the United Statesand#8221;and#151;Kirkus
and#147;Their argument has intuitive appealand#133;[and] is made more attractive by their clear prose and by their many helpful descriptions and historical explanations of US health care policy.and#8221;and#151;Arnold Relman, New York Review of Books
and#147;Admirably presented as an apolitical examination of an urgent situation, Bradley and Taylor's carefully researched and lucidly reported findingsand#133;offer what appears to be an easily rendered fix, but their equally striking depiction of uniquely American hostility to government involvement in private matters, exposes a daunting uphill battle.and#8221; and#151;Publishers Weekly
"If weand#8217;re so rich, why arenand#8217;t we healthier? Iand#8217;d wondered about that for years, always assuming it was a medical question with a medical answer. I now know the answer lies not in what happens in our hospitals but what happens (or fails to happen) in our social services. This compelling, groundbreaking, and utterly persuasive book has opened my eyes." and#151;Anne Fadiman, author of The Spirit Catches You And You Fall Down
"This book provides new insight on why it is the United States' is spending so much on medicine without seeing commensurate health outcomes. Bradley and Taylor provide a clear account of life in the chasm between health and social services, where so much of our health care investment is lost, and put forth concrete ideas on how we can do better."
and#151;Dr. Paul Farmer, MD, PhD, Harvard Medical School, Brigham and Womenand#8217;s Hospital, Partners In Health, and author of To Repair the World and Haiti After the Earthquake
"Bradley and Taylor have identified social services as the unnamed culprit behind high health care costs and poor outcomes. Highlighting the non-medical determinants of patientsand#8217; health may not only make physiciansand#8217; jobs easier but also prove to be a prudent strategy for payers. This book offers an important reality check about what actually creates health in the United States."
and#151;William Gillespie, MD, Chief Medical Officer of Emblem Health, and president of AdvantageCare Physicians
"It seems like there are daily stories of skyrocketing medical costs here in the US coupled with our bad health outcomes compared with other developed countries. This book argues compellingly that we may have been looking for solutions in the wrong places. We wonand#8217;t find the answers by changing medical payments or improving quality of care as important, as those are. But rather that health begins, is nurtured, protected and preserved in our families and neighborhoodsand#151;where people live, learn, work and play. The authors find that supporting families and children in ways that make their houses, neighborhoods and schools secure and enjoyable pays off in health in concrete and measurable ways. It is time we started to get serious about building a culture of health and making it easier for people to live that kind of life than merely paying the costs to repair the damages from injury and disease." and#151;James S. Marks, MD, MPH, president and director of Health Group at the Robert Wood Johnson Foundation
"The challenge of addressing social as well as health needs is daunting. One could become and#147;paralyzed by the complexity inherent in the relationships among health, social services, and health outcomes, andand#133;consider strategic action all but impossible.and#8221; The book provides a counterweight to such pessimism. The authors examine four case studies of successful and#147;home grown innovationsand#8221; that provide evidence that it is, in fact, feasible to integrate social and medical services."and#151; Health Affairs
and#147;These authors offer us a comprehensive view of our healthcare system. I enthusiastically recommend this book for all nurses.and#8221; and#151;American Holistic Nurses Association
"The U.S. has worse health outcomes than other wealthy countries not only because of a deeply flawed insurance system, but also because it spends less than other countries on the fundamentals of life that affect peopleand#8217;s health, including education, housing, good jobs, nutrition, and environmental protection."and#151;World Wide Work bulletin
andldquo;The supply side is the great neglected side of the health-care debate, and Mulligan has written the best book on it to date.andrdquo;
andldquo;In Side Effects and Complications Mulligan provides an in-depth examination of the future of health care in the United States through a perceptive analysis of the unintended consequences of the new health-care law. and#160;The book focuses on the incentive effects of the Affordable Care Act on employment. and#160;At a time when our economy isnand#39;t creating many andlsquo;good jobs,andrsquo; could this law impede progress? Mulligan masterfully applies insights from price theory to one of the most crucial public policy issues of our era.and#160;andldquo;
andldquo;When the government subsidizes health insurance for people who do not have full-time jobs, that subsidy discourages work and job creation, just as much as a tax of thousands of dollars on employment would do. In this splendid book, Mulligan comprehensively surveys this and related disincentives created by the many pieces of the Affordable Care Act, and he estimates their overall effect on employment and economic growth. You will come away shocked at how unaffordable the act is for the economy as a whole.andrdquo;andnbsp;
Why, when the U.S. spends more money on medical care for its citizens than any other country, are Americans getting sicker and dying younger? The director and program manager of the Global Health Leadership Institute at the Yale School of Public Health provide provocative answers for the post-Obamacare era.
Foreword by Harvey V. Fineberg, President of the Institute of Medicine
For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: Weand#8217;ve left out of our tally the most impactful expenditures countries make to improve the health of their populationsand#151;investments in social services.
In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of and#147;health care,and#8221; archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care and#147;systemand#8221; developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.
Offering a unique and clarifying perspective on the problems the Affordable Care Act wonand#8217;t solve, this book also points a new way forward.
About the Author
Elizabeth H. Bradley
is professor of public health at Yale University, faculty director of its Global Health Leadership Institute, and master at Branford College. The recipient of a Bill and Melinda Gates Foundation grant, she was previously director of the health management program and co-director of the Robert Wood Johnson Clinical Scholars Program at Yale and served as hospital administrator at Massachusetts General Hospital. She lives in New Haven, Connecticut.
Lauren A. Taylor studies public health and medical ethics at Harvard Divinity School, where she is a presidential scholar. She was formerly a program manager at the Yale Global Health Leadership Institute, where she led a research team in building a model for scaling up public health innovations for the Bill and Melinda Gates Foundation. She completed a masterand#8217;s in public health at Yale University in 2009. She lives in Boston, Massachusetts.
Table of Contents
1 The Paradox of Affordability
2 Too Good to Be True: The Health Reformandrsquo;s Hidden Taxes
3 Some Unpleasant Penalty Arithmetic
4 Some Unpleasant Subsidy Arithmetic
5 Exchange Subsidies and Their Implicit Income Taxes
6 Consequences for Employee Work Schedules
7 Adam Smithandrsquo;s Equalizing Differences: More Hidden Taxes and More Health Coverage
8 The ACAandrsquo;s Productivity Distortions
9 Other Significant Causes of Economic Change, 2007andndash;2017
10 Romneycare Times Eleven