Health Care Reform

"[Health Care Reform offers] an easy-to-understand cartoon walk through the health care policy landscape . . . Readers see patients, workers, employers and others confront some of the legislation's knotty issues, especially the mandate requiring everyone to have health insurance . . . Prominent among the book's comic characters is its author, Jonathan Gruber. Dr. Gruber, an economist at the Massachusetts Institute of Technology, consulted with the Obama administration and Congress as the legislation was drafted, and he was one of the architects of the plan on which it is based, the Massachusetts health care law . . . For critics of either law, Dr. Gruber's résumé offers reason enough to consign the book to the dustbin. But that would be a mistake. Though in the book, the cartoon Dr. Gruber makes no bones about his enthusiasm for the laws, he also lays out even-handedly what the biggest problems are with the way we finance health care today and how the federal law addresses them. Through drawings by Nathan Schreiber, the book tracks the journeys of four fictional Americans: Anthony, who is, like most of us, an employee of a company with health benefits; Betty, who is covered by Medicare; Carlos, whose employer does not offer health benefits, leaving him to the mercy of the 'nongroup market'; and Dinah, who has no coverage at all. As we follow them through job loss, auto wrecks and other health care woes, we absorb vivid lessons in what Dr. Gruber calls 'the two-headed beast' of American health finance: rising costs, and the rising numbers of Americans without adequate health insurance. Cartoon characters in the book raise many of the questions Americans have wondered about. For example, the fact that thousands of Americans die each year because of inadequate insurance coverage may be 'all very sad,' the employed Anthony says, 'but I am insured. Why should I care?' Employer-sponsored coverage is eroding, the cartoon Dr. Gruber tells him. And anyway, he asks, 'what are you going to do for coverage if you get laid off or your employer stops offering it?' The book explains how the act bars insurance companies from dropping people who get sick, or charging them more, or refusing to cover care for pre-existing conditions. It also tells what happened when five Northeastern states tried to carry out these rules: 'Those five states became five of the most expensive places in the nation' for insurance customers outside of large group plans. 'But there is a solution,' the cartoon Dr. Gruber goes on. 'If we could guarantee that folks wouldn't just buy insurance when sick, then insurers could price fairly.' What is this guarantee? The individual mandate, perhaps the most controversial element of the federal health law . . . Under the mandate, people who do not have government- or employer-paid coverage will have to buy it, with help from government subsidies if they qualify. As a result, the pool of insurance customers will grow, in theory keeping rates down . . . As the experience of the New England states shows and as the Obama administration has asserted, other features of the law may be unworkable without the mandate. Many healthy people would probably choose not to buy insurance, the cartoon Dr. Gruber explains, because under the law they will be able to buy it without substantial penalty if they need it. The result: higher rates for everyone . . . Dr. Gruber acknowledges that the full effect of the act is impossible to know until it plays out. He notes that the Congressional Budget Office predicts it will produce substantial big spending cuts, but he concedes that cost-cutting changes 'aren't easy to make.' Going forward, he says, we will have to learn 'what works and what doesn't.' That, too, like the book as a whole, is fair enough."—Cornelia Dean, The New York Times

"If you want to learn about health care reform, you can do no better than to learn from the master. Jonathan Gruber shows how health care reform works in a way that everyone can understand. Read this book. You will not regret it."—David Cutler, Professor, Department of Economics and Kennedy School of Government, Harvard University

"Jonathan Gruber's straightforward explanation of what the Affordable Care Act does and why will help people understand what's true and what's false about the health reform law. His message is clear and easy to get: when it comes to health care, we're all in it together; and, together, we will benefit from making the Affordable Care Act a success."—Judy Feder, Professor and former Dean, Georgetown Public Policy Institute

"Jonathan Gruber, one of the country's smartest health care minds, has brought the epic struggle of health reform to life. By explaining the challenges in our health care system as well as the benefits of the reform with imagination and verve, he accomplishes what many have tried and failed to do—he makes the case for health reform as an important achievement for the American people."—Neera Tanden, President of the Center for American Progress

"Having spent years working to make health care work for Americans, Jonathan Gruber has now provided another service: walking everyone through the benefits of the Affordable Care Act reforms so consumers are armed with accessible information. In an age when information is power, Gruber's book is fun and informative, and it boils down the facts of health care reform for all Americans."—Senator John Kerry

A cartoon-driven examination of what's wrong with the American way of health care—and why the legislative reform of 2010 was necessary. 'Every one of us knows that America's health care system is a mess,' writes Gruber, who helped draw up the Massachusetts reforms for which Mitt Romney is now taking such a beating from the right. And for good reason: The hard right characterizes any kind of government management of health care as socialism, while others across the political spectrum believe that the unchecked profit motive assures that health care will remain expensive and differentially accessible. Gruber turns up some astonishing figures for which Schreiber's accompanying illustrations carry an appropriate sense of alarm. For instance, in 1960 health care cost less than 3 percent of the federal budget, while the 'largest single expenditure now is on health care,' likely to incur a deficit of $100 trillion—that's trillion with a tee—in the near future . . . examining the big business that health care has become. By way of a pointed example, he considers what would happen to four very different people given the same medical emergency, namely a heart attack: Someone with decent benefits would be covered, while someone working on the fringe of the economy, as so many are these days, would pay most expenses out of pocket—and if he or she could actually get private coverage, it would be costly and incomplete. The Massachusetts plan, Gruber maintains, offers one cure, though the insurance industry has done all that it could to void the spirit if not the letter of the law. The omnibus health-care reform act that narrowly squeaked through Congress is a necessary start, but with more to do. Timely and informative. Where was so clear an explication during the health-care brouhaha on Capitol Hill?"—Kirkus Reviews

"As its subtitle indicates, this book is about more than entertainment. It delivers information, like Scott McCloud's Understanding Comics, through an earnest but informal lecture by a cartoon version of an expert—in this case Gruber, an MIT economics professor who helped craft Massachusetts's successful health care reform plan as well as the Affordable Care Act, which has been the subject of so much confusion and deliberate misinformation. He begins the presentation by confronting a small group of people with the enormous medical bills they could receive after medical treatment, then moves from the individual to the national level to show that our present system is unfair and unsustainable. The explanation of how the ACA can fix the problems may not convince all readers, but they'll come away with a clearer understanding of what the real issues are. Schreiber's simple black and white art effectively uses symbols and some basic charts to help explain the morass. An effective use of comics as part of a public policy debate.—Publishers Weekly