Debates on U.S. Health Care

Debates on U.S. Health Care


Edited by: Jennie Jacobs Kronenfeld, Wendy E. Parmet & Mark A. Zezza

  • Publisher: SAGE Publications, Inc. |
  • Publication Year: 2012 |
  • Online Publication Date: November 30, 2012 |
  • DOI: |
  • Print ISBN: 9781412996020 |
  • Online ISBN: 9781452218472


This issues-based reference work (available in both print and electronic formats) shines a spotlight on health care policy and practice in the United States. Impassioned debates about the best solutions to health care in America have perennially erupted among politicians, scholars of public policy, medical professionals, and the general public. The fight over the Health Care Reform Act of 2009 brought to light a multitude of fears, challenges, obstacles, and passions that often had the effect of complicating rather than clarifying the debate. The discourse has never been more heated. The complex issues that animate the health care debate have forced the American public to grapple with the exigencies of the present system with regard to economic, fiscal, and monetary policy, especially as they relate ...

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    About the Editors

    Jennie Jacobs Kronenfeld is a professor in the Sociology Program in the School of Social and Family Dynamics, Arizona State University. Her research areas are medical sociology and aging and the life course with a special focus on health policy, health care utilization, and health behavior. She has recently published Medicare by Greenwood Press (2011) and serves as the editor of the research annual Research in the Sociology of Health and Health Care published each year by Emerald Press. She is co-editor of Health and Associate Editor In Chief of American Journal of Health Promotion. Her current research interests in addition to health policy include research on gender and health, and research on aspects of obesity as linked to social factors.

    Wendy E. Parmet is George J. and Kathleen Waters Matthews Distinguished Professor of Law and Associate Dean for Academic Affairs at Northeastern University School of Law, where she is also Director of the Program on Health Policy and Law. She is the author of Populations, Public Health, and the Law, published by Georgetown University Press in 2009 and with Professor Patricia Illingworth, Ethical Health Care, published by Prentice Hall in 2005, as well as numerous articles in medical, legal, and public policy journals on public health law, health care access, bioethics, and disability law. Professor Parmet has served as counsel on several major court cases involving health care access. She received her JD from Harvard Law School and her BA from Cornell University.

    Mark A. Zezza, PhD, currently works at the Commonwealth Fund as a Senior Policy Analyst. His main issues of interest relate to payment and delivery system reform, with a focus on the development of accountable care organizations. Dr. Zezza joined the Commonwealth Fund from the Engelberg Center for Healthcare Reform at the Brookings Institution, where he managed projects evaluating and providing implementation support to health-reform initiatives on accountability payment models, health information technology, and quality measurements. Prior to Brookings, Dr. Zezza was Associate Director at the Lewin Group, working as a member of the State Healthcare Reform team to analyze the economic and coverage effects of various reform proposals. From July 1999 through 2006, Dr. Zezza worked at the Centers for Medicare & Medicaid Services analyzing and helping to operationalize various Medicare payment systems. He holds a BS in Math and Psychology from Dickinson College, an MA in Economic Policy Analysis from the University of Maryland, Baltimore County and a PhD in Public Policy from the same institution.

    About the Contributors

    E. Kathleen Adams, PhD, is a health economist with over 25 years experience in applied health services research. She is Professor at the Rollins School of Public Health at Emory University where she teaches public finance in the Department of Health Policy and Management and completes research on the effects of health policy on low-income and vulnerable populations.

    Ellie Andres, MPH, is a researcher in the Department of Health Policy at the George Washington University School of Public Health and Health Services. Her research focuses primarily on health care access and quality for vulnerable populations, such as immigrants and children.

    Tishra Beeson, MPH, is a researcher in the Geiger Gibson Program in Community Health Policy, in the Department of Health Policy at the George Washington University School of Public Health and Health Services. She conducts research on Federally-Qualified Health Centers and other safety-net providers with a focus on expanding access to primary care services in underserved communities. Ms. Beeson received her master's degree in public health from Oregon Health and Science University and is currently a doctoral student in public health at the George Washington University.

    Lilliana L. Bell, MHA, is a Research Program Manager in the Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions at the University of Florida. She serves as the Research Program Manager for the evaluation of Florida's Section 1115 Research and Demonstration Waiver program. Ms. Bell is also an Adjunct Assistant Professor in the Bachelor of Applied Science in Health Services Administration program at Santa Fe College in Gainesville, Florida.

    Carl Berdahl graduated with honors from the Yale University School of Medicine in 2012, and he now works as an emergency medicine resident at Los Angeles County Hospital/USC. His research interests include health services, resource utilization, disparities, and public health.

    Dhrubajyoti (Dru) Bhattacharya, JD, MPH, LLM, is the Director of the health policy and law track for the MPH program at Loyola University Chicago; Assistant Professor of Health Policy in the Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine; and also serves as a Visiting Professor of Law at Loyola University Chicago School of Law. He received his LLM from Georgetown University Law Center and his MPH from Johns Hopkins Bloomberg School of Public Health.

    Julia Bienstock is a law student at Fordham University School of Law. She has studied international health systems and has worked at the National Health Law Program and the Legal Aid Society's Health Law Unit. She is currently a staff member of Fordham's Urban Law Journal.

    Joel C. Cantor, ScD, is the director of the Center for State Health Policy and professor of public policy at Rutgers University in New Brunswick, New Jersey. He has authored numerous studies of health insurance regulatory policy, health care delivery system performance, and access to care for low-income and minority populations. Cantor received his doctorate in health policy and management from the School of Public Health, Johns Hopkins University.

    Kathleen Carey, PhD, is a Professor in the Department of Health Policy and Management at the Boston University School of Public Health where she teaches Health Economics and conducts research in health economics and health care policy. She also holds an appointment as an economist with the VA Center for Health Outcomes, Quality and Economic Research.

    David W. Carlson is with PharmaMetrics, Inc.

    Crystal Wiley Cené, MD, MPH, is Assistant Professor at the University of North Carolina (UNC) at Chapel Hill. She completed her medical degree at the Brody School of Medicine at East Carolina University and internship and residency at the Yale University Primary Care Internal Medicine Residency. She also completed her master's in Public Health and a 3-year General Internal Medicine Fellowship at Johns Hopkins University. Dr. Cené is a practicing general internist and physician-researcher at UNC.

    Marcelo Coca-Perraillon is a PhD student in the department of Health Studies at the University of Chicago. Before joining the University of Chicago, he was a researcher at the National Bureau of Economic Research (NBER) in Cambridge, Massachusetts.

    William S. Custer is Director of the Center for Health Services Research in the J. Mack Robinson College of Business at Georgia State University. Dr. Custer's research has investigated a wide range of topics including the sources of health insurance coverage, employment-based health insurance, health plan cost management initiatives, and health insurance regulation.

    Corey Davis, JD, MSPH, is a Staff Attorney with the National Health Law Program and the Network for Public Health Law. His writing on the intersection of law and public health has appeared in publications including the American Journal of Public Health, the American Journal of Bioethics, and the Clearinghouse Review Journal of Poverty Law and Policy. He is licensed to practice law in Pennsylvania, New Jersey, and numerous federal courts.

    Aubrey M. Denmon is a doctoral student in the Department of Sociology at the University of Georgia. She holds a master's degree in Public Health from the University of Georgia, and a Bachelor of Arts from Agnes Scott College. Her current research focuses on illness narratives among college students.

    Diane Dewar is the Associate Dean for Academic Affairs at the School of Public Health and Associate Professor in the Departments of Health Policy, Management and Behavior and Department of Economics at the University at Albany, State University of New York. Her research focuses on the economic evaluation of programs and treatments for vulnerable populations and those with chronic conditions. She is the author of Essentials of Health Economics, a text geared toward noneconomists.

    R. Paul Duncan, PhD, is the Malcolm and Christine Randall Professor and Chair of the Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions at the University of Florida. Dr. Duncan is also the Director of the Florida Center for Medicaid and the Uninsured, where his work is focused on health insurance, the uninsured, Medicaid, and state program evaluations.

    Leonard M. Fleck, PhD, is Professor of Philosophy and Medical Ethics in the Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University. He is the author of Just Caring: Health Care Rationing and Democratic Deliberation, as well as 90 articles and book chapters on a range of issues in medical ethics and health care policy. He is also one of the editors for the forthcoming volume Fair Rationing at the Bedside.

    Seth Freedman is an Assistant Professor at the Indiana University School of Public and Environmental Affairs and was a Robert Wood Johnson Scholar in Health Policy Research at the University of Michigan from 2010 through 2012. He received his PhD in Economics from the University of Maryland. His research interests are in health economics and health policy, particularly competition and financial incentives in provider markets.

    Bianca K. Frogner, PhD, is an assistant professor in the Health Services Management and Leadership Department in the School of Public Health and Health Services at The George Washington University. As a health economist, her areas of research have included modeling the growth of health care spending, international health systems comparisons, trends in health care workforce as it relates to technology, and other topics in health care financing. She received her BA from University of California, Berkeley and PhD from Johns Hopkins Bloomberg School of Public Health.

    Barry Furrow is a Professor of Law and Director of the Health Law Program at the Earle Mack School of Law at Drexel University. He publishes books and articles in the area of patient safety, medical liability reform, and bioethics generally.

    Elise Gould is Director of health policy research at the Economic Policy Institute. She has authored a chapter on health in The State of Working America 2008/09, coauthored a book on health insurance coverage in retirement, published in venues such as The Chronicle of Higher Education, Challenge Magazine, and Tax Notes, and academic journals including Health Economics, Journal of Aging and Social Policy, Risk Management & Insurance Review, Environmental Health Perspectives, and International Journal of Health Services. She holds a master's in Public Affairs from the University of Texas and a PhD in Economics from the University of Wisconsin.

    Linda Grant is Professor of Sociology and a faculty affiliate of the Institute for Women's Studies at the University of Georgia. She previously taught at Southern Illinois University-Carbondale, where she held a cross appointment with the School of Medicine. Her research has focused on the impact of gender on careers in medicine and academic science. She holds a PhD degree in Sociology from the University of Michigan-Ann Arbor.

    Allyson G. Hall, PhD, is an Associate Professor and Associate Director of the Florida Center for Medicaid and the Uninsured in the Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions at the University of Florida. Dr. Hall is also the Director of the Florida Office on Disability and Health. Dr. Hall's research centers around issues related to access to care for vulnerable populations including those who are low-income or live with a disability.

    Randy Haught is a Senior Director at the Lewin Group. He has 20 years of experience in data analysis and microsimulation modeling of health care financing and policy-related issues. Mr. Haught has extensive experience in modeling the impact of the Patient Protection and Affordable Care Act and other health care reform proposals on major stakeholder groups including governments, business, providers, and households.

    B. Jessie Hill is a Professor of Law at Case Western Reserve University. Her teaching and scholarship focus on constitutional law, civil rights, reproductive rights, and law and religion. She is a frequent lecturer and consultant on reproductive rights issues.

    David Himmelstein has practiced primary care internal medicine and taught health policy research at Harvard Medical School. Since 2009, he has been a Professor of Public Health at City University of New York. He has authored more than 100 articles on various health policy topics, many of them with Dr. Steffie Woolhandler.

    Michael Hochman is a general internist and a fellow in the Robert Wood Johnson Foundation Clinical Scholars program at the University of California, Los Angeles, and the Veterans Administration of Greater Los Angeles. He has published original medical research about comparative effectiveness research as well as other topics. Dr. Hochman has also written about medical topics for the Boston Globe and several other lay media publications.

    Jason Hockenberry is an Assistant Professor in the Department of Health Policy and Management, Rollins School of Public Health, Emory University. He was previously a faculty member at the University of Iowa Department of Health Management and Policy, where he taught courses on health insurance and managed care and health economics. His primary research focus is on the impacts of provider human capital, technology diffusion, and policy on the quality and efficiency of health care.

    Jill R. Horwitz is Professor of Law and Co-Director of the Program in Law and Economics at the University of Michigan Law School. She also holds appointments at the University of Michigan School of Public Health, Ford School of Public Policy, University of Victoria Department of Economics, and the National Bureau of Economic Research. Her scholarly interests focus on health policy, as well as the legal regulation of health care organizations, nonprofit law, law and economics, and tort law.

    David Howard is a professor in the Department of Health Policy and Management at Emory University. A health economist by training, Dr. Howard's research focuses on the impact of evidence on use of technology and the cost and value of cancer treatment and screening. Dr. Howard received his PhD in Health Policy from Harvard University.

    Patricia Illingworth teaches in the Department of Philosophy, the College of Business Administration and in the Law School at Northeastern University. She has held fellowships at Harvard Law School and Harvard Medical School. She is the author of Us Before Me: Ethics and Social Capital for Global Well Being and Trusting Medicine: The Moral Costs of Managed Care and co-editor of Giving Well: The Ethics of Philanthropy, Ethical Health Care and The Power of Pills.

    Peter D. Jacobson, JD, MPH, is Professor of Health Law and Policy, and Director, Center for Law, Ethics, and Health, at the University of Michigan School of Public Health. He teaches courses on health law, public health law, and health care regulations. Jacobson's current research includes projects on public health entrepreneurship, safety net services, and how state and federal laws influence public health preparedness. In 1995, he received an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation to examine the role of the courts in shaping health care policy. Jacobson's most recent books are Law and the Health System (coauthored with Lawrence O. Gostin, Foundation Press, 2005), and False Hope vs. Evidence-Based Medicine: The Story of a Failed Treatment for Breast Cancer (coauthored, Oxford University Press, 2007).

    David K. Jones, MSPH, is a doctoral student at the University of Michigan, joint with the Department of Health Management and Policy in the School of Public Health and the Department of Political Science. His dissertation examines political and policy issues surrounding the implementation of the Affordable Care Act.

    Jennifer M. Kerner, MPH, is a Political Science Doctoral Student at the University of New Mexico, Albuquerque. She received her master's in Public Health from Indiana University, Bloomington where her research focused on violence as a public health issue. Her current research interests include transitional justice, politics of violence, and international relations, specifically with regard to the African continent.

    Patricia G. Ketsche is an associate professor in the Institute of Health Administration at Georgia State University. Dr. Ketsche focuses her research on financing and organization of health care in the United States with a particular interest in studying the intersection between public and private financing mechanisms.

    Simeon Kimmel is an MD/PhD student at Harvard Medical School and the Harvard Graduate School of Arts and Sciences where he studies medicine and medical anthropology respectively. He has completed three years of medical school and is in his first year of graduate school.

    R. Tamara Konetzka is Associate Professor at the University of Chicago, Department of Health Studies. She conducts research in health economics, aging and long-term care, quality of care, hospital markets, and Medicare and Medicaid policy, focusing on the interplay between economic incentives and quality of care. Professor Konetzka holds a PhD in health economics and health policy from the University of North Carolina at Chapel Hill and completed a post-doctoral fellowship at the University of Pennsylvania.

    Elizabeth Weeks Leonard is a professor at the University of Georgia School of Law, where she teaches health care law and tort law. She has published numerous book chapters and articles on health care financing and regulation, public health law, and health care reform. Professor Leonard received her BA from Columbia University and JD from the University of Georgia.

    Katy Mahraj received her Master of Science in Information, focused on health informatics, from the University of Michigan School of Information and Graduate Certificate in Health Informatics from the University of Michigan School of Information and School of Public Health in 2012. She earned her Bachelor of Arts summa cum laude from Harvard University in 2008. Currently, she is a health information analyst at Altarum Institute, a nonprofit health research and consulting company, in Alexandria, Virgina.

    Thomas R. Marshall completed his PhD at the University of Minnesota and now teaches at the University of Texas at Arlington. His work focuses on the impact of public opinion on policymaking. Currently he is researching public opinion and health care, particularly public opinion toward smoking and health-related issues. His most recently published book is Public Opinion and the Rehnquist Court (2008).

    Danny McCormick, MD, MPH, is an Assistant Professor of Medicine at Harvard Medical School, Director of the Division of Social and Community Medicine in the Department of Medicine at the Cambridge Health Alliance and co-director of the Harvard Medical School Fellowship in General Medicine and Primary Care. He received his internal medicine training at the Boston City Hospital and his general medicine fellowship training at the Massachusetts General Hospital/Harvard Medical School. He also holds an MPH from the Harvard School of Public Health. He is a health services researcher with an interest in access to and quality of care for underserved populations and practices primary care internal medicine at a public hospital affiliated community health center. He served as a Robert Wood Johnson Foundation Health Policy Fellow in Washington, D.C., and as a staff member of United States Senate Committee on Health Education Labor and Pensions under Senator Edward M. Kennedy.

    Benjamin Mason Meier is an Assistant Professor of Public Policy at the University of North Carolina at Chapel Hill. Dr. Meier's interdisciplinary research, at the intersection of international law, public policy, and public health, examines legal frameworks for global health. Working collaboratively across UNC's Department of Public Policy and Gillings School of Global Public Health, he has written and presented extensively on the development of rights-based public health policy pursuant to state, national, and international law. He received his PhD in Sociomedical Sciences from Columbia University, his JD and LLM in International and Comparative Law from Cornell Law School, and his BA in Biochemistry from Cornell University.

    Tom Miller is a resident fellow at the American Enterprise Institute, where he focuses on health policy. He was a member of the National Advisory Council for the Agency for Healthcare Research and Quality from 2007 to 2009 and previously served as a senior health economist for the Joint Economic Committee. He is a coauthor of Why Obama Care Is Wrong for America.

    Dinushika Mohottige is a fourth year medical student at the University of North Carolina (UNC) School of Medicine in Chapel Hill. She received her MPH at the UNC Gillings School of Global Public Health in 2008, and completed a Bachelor of Arts in Public Policy at Duke University.

    Alan C. Monheit is Professor of Health Economics at the School of Public Health, University of Medicine and Dentistry of New Jersey, a research professor at the Rutgers Center for State Health Policy, and a research associate of the National Bureau of Economic Research. Dr. Monheit is editor of Inquiry: The Journal of Health Care Organization, Provision, and Financing, a member of the National Academy of Social Insurance, and a fellow of the Employee Benefits Research Institute. His research interests include the relationship between employment and health insurance, the uninsured population, health insurance reform, the distribution of health spending, and the determinants of population health.

    Elaine Morrato, DrPH, MPH, CPH, has over 20 years of experience in health outcomes research with a focus on the diffusion and clinical translation of pharmaceutical innovation and policy. She is an Assistant Professor in the Department of Health Systems, Management & Policy in the Colorado School of Public Health, University of Colorado Denver and Assistant Director for the Children's Outcomes Research Program. Dr. Morrato has a career development award to study the diffusion of comparative effectiveness evidence into clinical practice and serves on the Key Function Committee for Comparative Effectiveness Research for the National Institutes of Health Clinical and Translational Science Awards.

    Shayla Nagy graduated with honors from Johns Hopkins University in 2012 with a bachelor's degree in Neuroscience. During this time she was a health economics intern at both the Brookings Institution and the Aspen Institute, and worked on maternal and child health policy at the Maryland State Medical Society.

    Dylan Nelson is a researcher in the Department of Health Policy at the George Washington University School of Public Health and Health Services, with particular interests in payment reform, population health, and disparities in care.

    Brenda Ohta, PhD, MSG, MSW, CPHQ, is a Senior Director for NYU Langone Medical Center administratively responsible for the departments of Care Management; Integrative Health Programs; Language, Cultural and Disability Services; and Ethics Consultation. Dr. Ohta holds an appointment as Adjunct Associate Clinical Professor at the NYU Silver School of Social Work, teaching in the graduate program on subjects related to hospital and health system policy. Her areas of research and program development focus on the impact of social determinants of treatment variation and patient care for older adults, factors affecting health care utilization, and the development of care management models to support patient care across the continuum.

    Stephen T. Parente, PhD, is the Minnesota Insurance Industry Chair of Health Finance in Carlson School of Management and the Director of the Medical Industry Leadership Institute at the University of Minnesota. As a Professor in the Finance Department, he specializes in health economics, health information technology, and health insurance.

    Kavita Patel is a Fellow and Managing Director of Delivery System Reform and Clinical Transformation at the Engelberg Center for Health Care Reform at the Brookings Institution. She was previously Director of Policy for the White House Office of Public Engagement and Intergovernmental Affairs and the Deputy Staff Director for the Senate HELP Committee, under the leadership of the late Senator Edward Kennedy. Dr. Patel is a board-certified physician with expertise covering delivery system reform, access, coverage, and quality.

    Jodyn E. Platt, MPH, is a doctoral student in the Health Services Organization and Policy Program at the University of Michigan School of Public Health. She received her MPH in health policy from the University of Michigan in 2005. Her research interests include science and technology studies, public health and health services systems, and public health genetics.

    David Randall, PhD, currently serves as Executive Director of the Consumer Driven Health Care Institute based in Washington, D.C. Randall has testified before both U.S. House and Senate committees of Congress on a variety of health policy issues and has extensive experience as a former top insurance regulator, legislative staff member, health care lobbyist, consultant, and executive. He received his PhD in political science (policy analysis and administration) from Kent State University and wrote his doctoral dissertation on the politics of Medicaid contracting and privatizing.

    Marsha Regenstein, PhD, is a professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services. Dr. Regenstein's work focuses on vulnerable populations, the safety net, quality of care and health care disparities.

    Sara Rosenbaum, JD, is the Harold and Jane Hirsh Professor of Health Law and Policy, George Washington University School of Public Health and Health Services. A nationally respected expert in health law and policy for over 35 years, Professor Rosenbaum is best known for her work in public and private health insurance and health care for medically underserved populations.

    Daniel B. Rubin is a law student at the University of Michigan Law School as well as a graduate student in the Ph.D. program in Health Services Organization and Policy, in the Department of Health Management and Policy, The University of Michigan School of Public Health. Before coming to the University of Michigan he received undergraduate training in neuroscience at Oberlin College, and a master's degree in Bioethics from Case Western Reserve University.

    Shenae K. Samuels, BS, is a Master of Public Health student in the College of Public Health and Health Professions at the University of Florida concentrating in Public Health Management and Policy. Ms. Samuels is a Graduate Assistant for the Florida Office on Disability and Health at the University of Florida and has interned at the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion as a Public Health Summer Fellow.

    Ronald Sandler is an Associate Professor of Philosophy and the Director of the Ethics Institute at Northeastern University. His primary research areas are ethical theory, environmental ethics, and ethics and emerging technologies. Sandler is author of Character and Environment: A Virtue-Oriented Approach to Environmental Ethics, Nanotechnology: The Social and Ethical Issues, and The Ethics of Species.

    Anthony L. Schlaff is the Director of the Public Health Program and Professor of Public Health and Community Medicine at Tufts University School of Medicine. He received a BA in history from Yale University, an MD from Columbia College of Physicians and Surgeons, and an MPH from Harvard University. He is board certified in Internal Medicine and Preventive Medicine and has been a part-time clinician through most of his career. His academic interests are in the intersection of medicine and public health and in the use of public health methods to address the social determinants of health.

    Kevin Seitz has over 40 years of experience in the administration of public and private health insurance programs. Over the years he has served as a hospital billing caseworker, legislative analyst, director for social services and Medicaid spending, director of Michigan's Medicaid program, president/CEO of the Blues' HMO in Michigan, and executive vice president at Blue Cross Blue Shield of Michigan. Seitz is an adjunct professor at the University of Michigan School of Public Health.

    Barbara Sheer, PhD, FNP, FAANP, is Professor Emeritus at the University of Delaware and a consultant at Nurse Consultant Associates (NCA). She has been actively involved in nurse practitioner (NP) movement for the past 40 years, was a Public Health Policy Fellow, and has held national and international positions in NP organizations. Among those positions were President of American Academy of Nurse Practitioners, Chair of the National Alliance of Nurse Practitioners, Chair of the American Academy of Nurse Practitioner Fellows, Chair of Communications and Core Steering Group Member for the International Council of Nurses Nurse Practitioner/Advanced Practice Nursing Network.

    Topher Spiro is the Managing Director of Health Policy at the Center for American Progress. He has worked on health care reform at both the federal and state levels, working to draft the Affordable Care Act as deputy staff director for health policy on the U.S. Senate Committee on Health, Education, Labor, and Pensions, and has also served as a health policy director for the Rhode Island Healthcare Reform Commission.

    Sally C. Stearns is with the University of North Carolina at Chapel Hill.

    Neera Tanden is President of the Center for American Progress and one of our nation's leading experts on comprehensive health care. She has previously served as a senior policy advisor for health reform at the Department of Health and Human Services, working to pass the Affordable Care Act, and has also served as a policy director for the Obama-Biden and Hillary Clinton presidential campaigns.

    Marianne Udow-Phillips, MHSA, is the director of the Center for Healthcare Research & Transformation, a health policy center based at the University of Michigan with a mission to promote evidence-based care delivery, improve population health, and expand access to care. From 2004 to 2007, Udow-Phillips served as director of the Michigan Department of Human Services, which handles Medicaid eligibility and all public assistance programs. Udow-Phillips is an adjunct professor at the University of Michigan School of Public Health.

    Steffie Woolhandler is a primary care physician and health policy researcher. She began her career at Harvard Medical School, where she was Professor of Medicine, and currently serves as Professor of Public Health at the City University of New York.

    Ruqaiijah Yearby is a Professor of Law and Associate Director of the Law-Medicine Center at Case Western Reserve University School of Law. In 2000, Professor Yearby earned her Master of Public Health from Johns Hopkins and her law degree from Georgetown, where she was on the Dean's List. Bridging the gap between numerous disciplines, her work has been cited in The Oxford Handbook of Bioethics (2007), Barry Furrow et al., Health Law: Cases, Materials and Problems (6th ed., 2008), Michele Goodwin, Black Markets: The Supply and Demand of Body Parts (2006), and in the written testimony of Professor Vernellia Randall before the United States Senate Judiciary Subcommittee on Human Rights and the Law (Dec. 16, 2009).

    Cynthia Zeldin is an MPH candidate in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University. She is also the Executive Director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization based in Atlanta. She holds an MA from the George Washington University and a BA from Emory University.

    Kai Zheng, PhD, is Assistant Professor in Information Systems and Health Informatics jointly appointed in the School of Public Health Department of Health Management and Policy and School of Information at the University of Michigan. His research draws on techniques from information systems research and human-computer interaction to study the use of information, communication, and decision technologies in patient care delivery and management. He is the recipient of the 2011 American Medical Informatics Association New Investigator Award that recognizes early-career achievements in health informatics and significant scholarly contributions.


    Reforming the health care system has occupied a major place in the public discourse long before President Obama signed the Patient Protection and Affordable Care Act (ACA). Since the ACA became law, national anxiety and heated political exchanges seem only to have intensified. The debates presented in this volume are designed to help readers make sense of the issues that trigger these arguments and arrive at judgments with the facts at their fingertips and a clearer understanding of what's at stake.

    The book is divided into three sections: Philosophical, Political, and Legal Debates; Economic and Fiscal Debates; and Quality of Care Debates. In each of these sections, critical issues are considered in a Point-Counterpoint format. The editors of each section selected the debate topics with two main things in mind: to ensure that the general issues surrounding health care reform are comprehensively discussed and to analyze the most contentious aspects of the ACA, in an effort to lay out the pros and cons in an analytical and objective manner.

    While the authors strongly make the case for each side, the Point and Counterpoint sections taken together will give the reader a well-rounded sense of the entire issue, allowing for an appreciation of both sides. It's possible that a reader might see the merits of the argument made on the Point side of the debate and then feel the same way about the Counterpoint. Often the validity of the conclusions of one side will not preclude the validity of those on the other—this represents just how complex and difficult these issues are to confront and solve. The goal is careful consideration of all aspects of health care reform—from all perspectives.

    That said, it is worth pointing out that the authors do, indeed, have strong points of view. Nonetheless, some authors contributed both Point and Counterpoint sides of particular debates; they were willing and able to set those views aside momentarily to explore aspects of the debate with which they may not personally agree.

    The introductions to each chapter aim to introduce these conflicting points of view. Written in an effort to contextualize each debate, they help to summarize the positions taken by the author and indeed will offer readers a road map into the Point and Counterpoint. The introductions invoke considerations for readers to be alert to as they reason through the arguments presented in each chapter.

    Each of the three sections also has an introduction, taking all the debates into account and connecting them together analytically. The editors, in these introductory essays, also offer historical context both in general terms and in terms of the current reform efforts under the ACA. Reading the section introductions alone will help to demystify much of the debate surrounding health care reform in the United States.

    One particular point of complication—something seemingly very simple—is the name of the 2010 reform measure. You will see different titles and acronyms that are generally used to signify the reform measure in total. The Patient Protection and Affordable Care Act was originally passed by the Senate in December of 2009. In order for it to get approval from the House, it was amended by Health Care and Education Reconciliation Act of 2010 (HCERA), which was passed by the House on March 21. Together these bills constitute the reform measure and collectively are generally referred to as the Affordable Care Act. In both the media and the political arena, the acronym ACA often is used as an umbrella term for both pieces of legislation, and we have done so here.

    The complexities surrounding the name of the measure reflect the difficult, even tortured, deliberations that Congress and the executive branch went through on their path to reform. The measure itself is a reflection of the conflicting interests and values embodied in the American public—all manifested in the political and philosophical arena—surrounding health care reform in general and the ACA in particular. These forces are still at play and, according to many analysts the ACA is simply one more step on the long road that United States is on to develop an equitable and efficient health care system.

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