Jacob S. Hacker is Professor of Political Science and Co-Director of
the Center for Health, Economic, and Family Security at U.C. Berkeley.
He is also a Fellow at the New America Foundation in Washington D.C.
Health reform is moving back to the top of the political agenda. Over the last fifteen years, the biggest problems in U.S. health care—the dwindling reach and generosity of private coverage, the rapid escalation of costs, the uneven quality of care—have all grown substantially worse. Now, we may well finally have a true opportunity to address these problems. What are the big issues at stake? What are the options for reform? And what are the prospects for real change after decades of political defeat?
These are the questions taken up in Health At Risk: America’s Ailing Health System–And How to Heal It, a book I recently put together that features the commentary of some of the nation’s leading experts on health care (plus yours truly). The book is premised on a simple notion: All of us are entitled to our own opinions about health care, but not our own facts.
The chapters in the book — on the uninsured, medical bankruptcy, the quality of American medical care, the consumer-directed health care movement, and the political prospects for reform — carefully examine these facts and offer original ideas for reform. The contributors don’t check their opinions at the door. But they all ground their arguments in the evidence, and express those arguments in clear and straightforward language. In short, the authors are experts who have written their contributions so that they are accessible to interested nonexperts—which, ideally, should include all Americans, so important is this discussion to us all.
In my (completely unbiased) view, the books makes a convincing,
evidence-based case for the necessity of major health reform. But don’t
take my word for it. Jon Cohn of the New Republic says of the book:
“These are some of the sharpest minds in the world of public policy,
brining unique expertise to bear on one of our nation’s most pressing
social problems.” Meanwhile, Senator Edward Kennedy (no stranger to
this issue) says that “At a critical time in our national debate on
health care reform, Jacob S. Hacker and his colleagues have given us an
invaluable guide to the future.”
You may wonder whether this debate is already over. Do the depressing new deficit numbers
and the massive (hopefully temporary) outlays necessary to save
capitalism from itself mean that health care is now just too expensive
As Health At Risk shows, this way of framing the question has it
exactly backward. To the extent that we’re worried about the budget and
the future of our economy, health care reform is more vital, not less
For starters, our long-term deficit problem is really a health care spending problem.
If you take health care programs out of the equation, there is
literally no other long-term federal budget problem. None. No Social
Security crisis. No out-of-control-earmarks catastrophe. No deficits as
far the eye can see.
And the health spending problem is a private crisis even more than a
public one. Federal and state coffers are suffering, but the pain is
even worse among families and private businesses—which lack the
government’s buying power. Even a modest slowdown in the rate of
increase of health spending would help public and private budgets
immensely. Put simply, we can’t afford not to tackle health care.
It would be one thing, of course, if we didn’t know how to do this.
But, as several of the chapters in Health At Risk carefully
demonstrate, there are plenty of programs both here and abroad that
show us how to provide much broader coverage and actually spend less
than we do now.
But there’s an even more basic point: As Health At Risk shows, health
care is at the epicenter of economic insecurity in the United States
today. If we are going to bailout Wall Street, shouldn’t we providing
decent health care to Main Street?
We should not close a golden of window of opportunity before it even
opens. Read Health At Risk and find out why seizing on that opportunity
is possible and crucial.