Understanding Health Care Reform: Bridging the Gap between Myth and Reality.
Article Type: Book review
Subject: Books (Book reviews)
Author: Wallace, Cara L.
Pub Date: 08/01/2012
Publication: Name: Health and Social Work Publisher: Oxford University Press Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Sociology and social work Copyright: COPYRIGHT 2012 Oxford University Press ISSN: 0360-7283
Issue: Date: August, 2012 Source Volume: 37 Source Issue: 3
Topic: NamedWork: Understanding Health Care Reform: Bridging the Gap between Myth and Reality (Nonfiction work)
Persons: Reviewee: Feldman, Arthur M.
Accession Number: 309792876
Full Text: Understanding Health Care Reform: Bridging the Gap between Myth and Reality. Arthur M. Feldman. Boca Raton, FL: CRC Press, 2012, 198 pages. ISBN: 978-1-4398-7948-1, $39.95 hardcover.

At the forefront during an election year, health care remains a central topic of debate across the country. Since the Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) passed in 2010, many Americans have wondered, "How does this legislation affect me?" As with most legislation, the complete text of the Act--which spans 959 pages--is cumbersome and overwhelming to read. In Understanding Health Care Reform: Bridging the Gap between Myth and Reality, Arthur M. Feldman successfully addresses the question to which so many Americans seek an answer: How does the Act affect the individual patient? He also examines the PPACA's effects on physicians, their practices, and the overall health care system. Feldman is clear that the Act's full impact remains undetermined, as rules by regulatory agencies are yet to be written, and some will be based on results from pilot studies and projects. He also notes that individual states will play a part in how the law is enforced and carried out at the state level. Feldman's overall goal in writing this book was to examine the strengths and weaknesses of the legislation and to provide insight for everyday American readers about how they can influence its success or failure. In one way, this book is a call to action; by providing the "information [needed] to make informed decisions," Feldman encourages individuals to "think creatively about how [they] will play a role in creating a better system of health care in America" (pp. xxi-xiii).

With much of the health care debate being fueled by political analysts, lobbyists, and the media, Feldman is a refreshing source of information. As a physician, he describes his experience in a variety of roles "[caring] for patients, [teaching] students, and [pursuing] research" (p. xi) within a variety of settings "in thirty different states and fifteen different countries" (p. xii). In addition to his perspective as a physician, he shares his personal experience as a patient battling prostate cancer. And he introduces readers to stories of other physicians, administrators, and patients,, examining the effects of the legislation and providing questions in each situation that will depend on the administration of the law. Feldman writes the book from the perspective that the Act provides a foundation for health care reform that must be built on by "[initiating] changes that will correct its deficiencies and enhance its strengths" (p. 181).

The book is divided into 11 chapters, with each of the first 10 exploring a different area that Feldman suggests is critical to understanding the strengths and weaknesses of the PPACA. This organization is crucial to the overall purpose of the book, as each chapter provides the framework necessary for outlining Feldman's proposed changes for ongoing reform. He presents a persuasive argument, supplying numerous and relevant references in the notes for each chapter. However, on the basis of the title Understanding Health Care Reform, one might assume that the book will provide a comprehensive summary of the PPACA itself, with a description of each of the 10 titles within the Act. Though Feldman makes multiple references to the Act, the organization and titles of the PPACA are not included, which may leave readers wondering whether they have a complete understanding. Including a more comprehensive summary of the Act and its organization, as well as tying each title to the 10 critical areas and suggestions, would have left readers with greater confidence in their ability to engage in political activism regarding reform.

The book is written in plain language and provides explanations for terms that may not be readily understood by a lay readership. Feldman writes in a way that does not assume extensive previous knowledge. The introduction provides a brief background on the passing of the PPACA and a description of how it will be enforced by regulatory agencies and the courts, including implementation at the state level. Feldman provides a perspective on why so many from both the political left and fight stand in opposition to the Act, even though most agree that the health care system is broken. Attempting to appeal to members across the political spectrum, he calls for politics to be put aside to ensure that quality of care and patient safety come first, followed by considerations of cost. A brief summary of each of the 10 areas is included in the introduction. This organization makes for easy reference by readers who may be interested in a particular area of reform, such as Medicare and Medicaid (chapter 2) or the role of preventive care (chapter 4). In this way, each chapter could ultimately stand on its own. Together, the chapters present a complete plan for further reform.

In chapter 1, Feldman focuses on the private insurance industry. Readers meet Susan, a young medical resident who discovers that she has a rare form of cancer, and her challenges with insurance coverage are explored. The private insurance industry is briefly described, followed by how the PPACA addresses some of what Feldman considers to be its more contemptible practices. He analyzes what is lacking in the Act, referring back to Susan and how her situation would be different now with changes from the PPACA and which problems could be addressed with further reform.

Chapter 2 examines the effect of health care reform on Medicare and Medicaid populations. The thorough descriptions of both programs will be useful to those who are not knowledgeable about them, another example of how Feldman works to make information accessible to lay readers. He addresses the development of pilot programs and project demonstrations, including how each might work and the areas in which they are lacking.

The basic format of the earlier chapters continues in chapters 3 through 10. Feldman introduces readers to individuals through vignettes, gives background information about each topic area, and describes the perceived impact of the PPACA, with suggestions and steps for improvement. Chapter 3 examines the issue of medical and economic waste; it is followed by a discussion of the role of prevention and wellness programs in chapter 4. Chapter 5 considers underserved populations and the hospitals that serve them, exploring the effect that health care exchanges might have. Feldman examines Massachusetts as a potential template for these changes and offers suggestions for supporting safety net hospitals. Improving quality of care, assessing the current lack of physicians in the workforce, and comparative effectiveness research are the topics analyzed in chapters 6, 7, and 8, respectively. Physicians' compensation (chapter 9) and tort reform (chapter 10), two critical issues in physician sustainability, are areas that Feldman portrays as wrongfully ignored within the legislation.

The final chapter is a summary, highlighting the changes that Feldman suggests will ensure successful provision of high-quality health care for Americans. His argument for political involvement is both timely and convincing, especially with the remaining need for rules and regulations to enforce the law. Although many may be persuaded by Feldman's call to action, some will likely need further instruction on how to get involved in reform efforts. Though he does well not to make assumptions of prior knowledge throughout most of the book, it appears that the process of political activism is a skill that he assumes of readers. Key guidelines for becoming involved at the state and federal levels are warranted but not provided.

Moving beyond the application for a general audience, this book is also an appropriate tool for health care professionals, policymakers, and elected officials. With the constitutionality of the PPACA being called into question before the Supreme Court, the future of health care policy is uncertain. As noted in the NASW (2008) Code of Ethics, social workers have an obligation to "engage in social and political action that seeks to ensure that all people have equal access" and to "advocate for changes in policy and legislation to improve social conditions." (section 6.04[a]). Health care reform is certainly relevant to this professional responsibility, and Understanding Health Care Reform provides an initial platform from which social workers and others can promote positive changes in national policy.

doi: 10.1093/hsw/hls024

Advance Access Publication October 3, 2012


National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/pubs/ code/code.asp

Patient Protection and Affordable Care Act, P.L. 111-148, 124 Stat. 119 (2010).

Cara L. Wallace

University of Texas at Arlington
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.