Paul Starr's Remedy and Reaction - Book Review

The passage of the Affordable Care Act has seen a number of books published about how the law was designed and successfully enacted, written by a wide range of authors from Tom Daschle to a team of Washington Post reporters. However, if you’re only going to read one book on the ACA and health reform, it should be Paul Starr’s Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform, which is due out from Yale University Press on October 25th.

You may know Starr, Professor of Sociology and Public Affairs at Princeton University, from his Pulitzer-Prize-Winning book on the history of the American health care system, The Social Transformation of American Medicine. In Remedy and Reaction, Starr is at it again, first chronicaling the history of health reform in America, then providing a behind-the-scenes look from his time in the Clinton White House working on what was ultimately a failed attempt at reform, and concluding with the politics and policy of the Affordable Care Act. For anyone who wants to engage in informed debate about health reform, Remedy and Reaction should be considered required reading.

Starr acknowledges at the outset that he is biased in favor of the ACA–and a progressive approach to reform more generally–but that doesn’t detract from what is, in my opinion, a balanced discussion of the issues at stake, and the evidence in support of various approaches to reform. His central premise is that the U.S. health care system is trapped–growing “increasingly costly and complicated” but having “satisfied enough of the public” and having “so enriched the health-care industry as to make change extraordinarily difficult.” As political moderates disappear from existence, the path to reform, Starr argues, has grown even more challenging.

The history is all here, from discussions of reform (and the lack thereof) by Presidents dating back to Teddy Roosevelt to the implementation of the ACA. It is striking to fully understand how our nation has been grappling with the same philosophical questions for a century without reaching any real consensus, while at the same time watching our problems mount as a result of our disagreement and inaction. It is eye-opening to watch as Republican ideas, espoused by Democrats in a spirit of cooperation, became antithetical to Republican ideals. When you finish Remedy and Reaction, you will know the truth about “death panels” and the tax breaks we give to those with the best insurance coverage. You will understand how an individual mandate can at once be viewed as the pinnacle of individual responsibility and the destruction of individual liberty. You will know where we came from and how we got here. And you will be both more enlightened and more cynical.