A Review of
Health Care Reform: What It Is, Why It’s Necessary, How It Works
Jonathan Gruber, with H.P. Newquist,
Illustrated by Nathan Schrieber.
Paperback: Hill & Wang, 2011.
Buy now: [ Amazon ]
Reviewed by Jess O. Hale, Jr.
With spring bringing us Marvel’s ” Avengers” out to rave reviews and giant box office and summer looking toward a new Batman movie, what better way to tide a politically-engaged readership of comic books over than a discussion of health care reform? Well, what if it came in the form of a graphic novel—does that help? I hope so, as lack of health insurance and spiraling costs are quite arguably more serious threats to young adults than Loki. Yet as we await a Supreme Court decision on the constitutional fate of the Affordable Care Act (ACA), the more neutral shorthand for Congress’ enactment of the health reform effort that President Obama pushed for and signed, many people know more about a movie about comic book characters than about the content of what the health reform legislation actually does. With a little help, MIT economist Jonathan Gruber has sought to explain the nuts and bolts of health care reform in a format readily accessible to many young adults (and quite a few older folk who are at least a little young at heart) – a graphic novel. Ably assisted by H. P. Newquist and Nathan Schreiber, Gruber has written Health Care Reform: What It Is, Why It’s Necessary, How It Works as an explanation of the ACA for those who are not political or policy junkies.
Actually Gruber has done a pretty good job of explaining the why and the what of health care reform. (The how of health care reform is perhaps more of an NC-17 story.). Readers need to be aware that Gruber is an advocate with a point of view – he thinks the ACA is a good thing, but he also is one of the most knowledgeable economists on health care economics in the country. As an academic economist Gruber did advise the Obama administration on reform, but he also was one of the key architects of the exchange model of health reform in Massachusetts under Governor Mitt Romney. He has worked with Democrats and Republicans. Gruber actually knows what he is explaining.
The format of Gruber’s Health Care Reform is not the colorful 40 page comic books of my youth, which taught me about Iron Man, as well as Jesus and Joshua in Sunday school. Rather his format is that of the graphic novel illustrated in black and white over about 150 pages. Now my previous exposure to the graphic novel started with my stepson’s copy of The Watchmen, so I found myself both comfortable and surprised as I started to read about health policy with pictures. To me Gruber’s approach is accessible to a rather broad readership.
The comic book/graphic novel approach does not permit technical precision, yet I found that pictures of people in various life situations significantly helped making the broad outlines of what is an exceedingly complex legislative and policy effort understandable at a practical and human level. As a lawyer who teaches health policy, I appreciate that benefit. For those who want an accessible traditional treatment of health reform I suggest Landmark by the Washington Post’s political reporters or Lawrence Jacobs and Theda Skocpol’s Health Care Reform and American Politics.
Over the course of twelve chapters, Gruber takes his readers on walk through health reform. Using four typical characters in different life situations who all go to the hospital for emergency care he explains the policy problems that reform seeks to address. We walk through an interaction with the health care system with a person who has good insurance through employer-based group insurance, a man with an individual health insurance policy, a senior citizen with Medicare, and an uninsured woman. He deftly explains how pre-existing conditions, shifting and rising costs affect both the care that people with similar health care needs receive and the way all of us pay for how our system finances the care some of us receive. He makes an argument that people need to be insured. From that base argument he walks through health reform in Massachusetts before explaining how people would get insurance under the ACA – with subsidies through exchanges and much more. Along the way he confronts myths, like “death panels,” and explains how cost control would work (though on cost control he may be a little optimistic). He explains how important “bending the cost curve” is to a sustainable health care system. He also tries to assure senior citizens that reform is not a bad thing for them. From a proponent of the ACA, this book represents a fair statement of the controversial legislation. A reader may disagree with his viewpoint, but there is value in understanding his perspective and goals.
While Gruber acknowledges that there is constitutional litigation about the ACA, this book tells a story about policy, not law. In understandable terms, he explains the critical role of the “mandate ” that people have health insurance to the interconnected changes to the insurance industry and the relayed cost control. He believes that reform will lead to healthier lives, more secure jobs, and more for all Americans – not quite a utopia or the Kingdom, but close from his point of view. That is Gruber’s take home, the comic book “Kapow” punch this book seeks to land.
The story Jonathan Gruber tells is an important one, but this is still a story about politics and health care as usual. The ACA does not transform the health care system as it builds on the insurance model we currently have. Some public health concerns, like obesity, are not driven by the lack of insurance, but insurance is important for caring for sick kids and paying for hospital care without financially ruining a family. Even in a penultimate sense, the kingdom where no child is sick does not arrive in Gruber’s tale, but good things do happen… and that is no small thing.