Understanding What Makes the Medicine Go Down

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Steven Brill’s America’s Bitter Pill does something remarkable. It makes sense of the US healthcare system.



The debate on the US healthcare system is as complicated – if not more so – than the system itself. Instead of distinct sides on most issues, battle lines are created by a group of coalitions that are in constant flux. More times than not, it’s difficult to tell which group has the public’s best interest in mind. All of this can be complicated to suss out. Luckily Steven Brill specializes in complicated.


In his latest book, America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, Brill dives head first into national policy issues regarding the US healthcare system. Specifically Brill focuses on the Affordable Care Act (aka “Obamacare”). Much of America’s Bitter Pill talks about the healthcare industry using the ACA as the backbone. Whether it’s the price of medication or how pharmaceutical companies play a role in creating healthcare laws, by framing the conversation to the ACA, Brill gives the reader a clearer picture not only of the ACA but the pitfalls – and some suggested solutions – to US healthcare policy as a whole.


America’s Bitter Pill chronicles the last seven years of the healthcare debate through a narrative approach. While it’s easy to see why some readers might be put-off by tackling healthcare policy in such a way (framing effect, choosing stories that best fit your narrative, ect), when a book does it right – see Michael Lewis’ Flash Boys – it can help decipher complicated issues more easily to outsiders. The way Brill navigates through the various acronyms, agencies, and people that affected the ACA is impressive. He has always had a skill in making opaque and complicated ideas easy for those on the outside to understand. America’s Bitter Pill is no different.


America's Bitter Pill Book Cover


Unlike most narrative approaches to journalism – where a story uses a single individual or idea to talk about larger issues – America’s Bitter Pill constantly shifts to various protagonists throughout it’s over 500 pages to create a patch quilt-like effect in talking about the US healthcare system. The book consistently changes view-points from politicians that tried to come up with bipartisan legislation on US healthcare reforms to patients (from various walks of life) interacting with a heartless system to entrepreneurs starting their “cool” new take on healthcare.


Each of these stories act like separate puzzle pieces only telling you specific aspects of a much larger system. Traditionally, books on US healthcare only go this far, but where America’s Bitter Pill sets itself apart is putting the puzzle pieces together, showing a larger picture. Brill does an excellent job in navigating a complicated and messy narrative. What you get is a basic understanding of the decisions that lead to the creation of the ACA and the US healthcare system as we know it today.


While the book’s conclusions come at times a bit scatter shot, it’s hard to come away from America’s Bitter Pill not having better understanding about the US healthcare system in general. That in itself makes it worth the read.



(Photo Credit: Random House)



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