Remedy and Reaction Response

In 2010, President Barack Obama signed into law the Affordable Care Act, a huge and unprecedented achievement that reformed the American healthcare system. It was a feat that many other leaders had previously attempted but ultimately failed to do. In Paul Starr’s Remedy and Reaction, the author and one of former President Clinton’s senior health advisors, take a close look at the various attempts to overhaul the nation’s healthcare system. From his detailed analysis of the many different congressional negotiations and political struggles that have taken place regarding healthcare reform, to the differing ideologies at play from both sides of the political aisle, Starr takes a subject that has driven many to become somewhat jaded and weary and breathes new life into it. Starr makes it clear that he believes that the differences in opinion when it comes to socialized medicine have to do with longstanding differences not only in opinion, but they are rooted in opposing worldviews. He also makes it clear from the outset that he does not intend to be objective in this endeavor, (which is a fact he cannot hide, given his role in the Clinton administration) and that he fully supports a broad-based national healthcare system.

Starr explains that any change in policy at the national level must go through our somewhat complicated parliamentary democratic system, “large-scale innovation in national policy has never been easy in the United States, nor was it intended to be” (Starr 3). There are so many hoops and obstacles along the way for a bill to become law that “supporters of major reform usually cannot put them into effect by winning only one election” (Starr 3). Starr goes onto explain in further detail that the only way for supporters of major policy reform to emerge victorious is to hold onto the reins of power for at least several elections in order to get bills to become law (3). Another very interesting fact is that many campaigns for national reform efforts start at the state level first. A prime example of this would be the universal healthcare that was passed in Massachusetts in 2006, during the tenure of former Massachusetts governor, Mitt Romney. Before the Massachusetts healthcare overhaul, efforts to overhaul the American healthcare system had been ongoing for nearly a century, beginning in 1915. Other than Medicaid being passed in 1965, many generations of Americans were left in the dark without much in the way of help or options when it came to healthcare and the financial burdens the predicament induced.

One of the strongest methods that Starr uses to illustrate the severity of the need to pass healthcare reform, is to provide raw data that plainly illustrates precisely how many Americans are being affected without coverage. Over the years, as the American population began to increase, and as economic turmoil wreaked havoc on many citizens, the number of uninsured continued to rise all the way to 16.7 percent of Americans, or 50.7 million people, in 2009. These are rather startling numbers, and they do a great job of spelling out just how enormous the problem of uninsured Americans really became. In a nation with a little over 300 million people, these numbers show the severity of the problem, with nearly 6% of the nations citizens lacking healthcare. Another fact that Starr includes that is also thought-provoking and more than a little unnerving, is that “By the second half of the century, the United States was the only major advanced society without a system for providing healthcare for all its citizens” (Starr 6). Perhaps one of the most effective arguments that Starr makes, is when he describes the amount of money the United States has spent on healthcare over the past 40 years. Starr explains that although a huge amount of Americans did not have access to healthcare, we still spend as much or more than other nations that do provide broad-based health coverage to their citizens. This fact highlights just how ridiculously out of control U.S. healthcare companies were allowed to become without more significant regulation. Another huge factor in the healthcare debate has been the role of special interests. These groups are made up of all those involved in healthcare, from insurance and pharmaceutical companies, to the hospitals and physicians that treat us. It is particularly interesting the way Starr describes U.S. physicians as having “historically opposed any intrusion by the state into their professional terrain that would limit their income or autonomy” (Starr 6). In fact, for 30 years in the mid-20th century, many physicians came together and fought against the idea of providing access to healthcare for all Americans. “The opposition of physicians and insurers in the first half of the twentieth century was unquestionably a factor in blocking adoption of early proposals for government health insurance programs” (Starr 6).

Based on Starr’s interpretation, it appears as though the real reason that so many Americans have been denied healthcare coverage for nearly a century comes down to money. This conclusion is made all the more clear by the way Starr describes the role and motivations of interest groups that have opposed the implementation of a national healthcare system. “Since every dollar spent on healthcare is also a dollar that someone earns from healthcare, interest groups predictably resist government policies that limit spending” (Starr 6). One of the greatest points the author makes when it comes to why it has been so difficult to reform healthcare in America, has to do not only with the complexity of the U.S. system, but also with the fact that our national healthcare debates take place in an already divided, fractured political environment, in which public trust in our elected officials is at an all-time low. Starr goes on to further explain that due to the negativity in our political climate, “cynicism undermines the belief in public remedy that is essential to any popular movement for large-scale change” (11).

In addition to providing a vast amount of background information on the efforts to improve healthcare over the years, the author also includes some very valuable firsthand information from his time as a member of the Clinton administration. The efforts made in the 1990’s toward reforming healthcare ended up failing, and although the Obama administration was able to finally reform healthcare in 2010, Starr points out that many of the same obstacles were still in place, and that in many ways the Democrats had it harder in 2009 due to the rise of a right-wing media outlets like Fox News that served to unite conservatives and help to shape opinion, and the decline of moderate republicans within the GOP’s ranks.

The most effective aspect of the book definitely has to be the way that Starr describes the history of healthcare reform efforts in America, and how and why they failed up until recently. When one closely looks at all the evidence and all the different parties at play, there is very little doubt left that national healthcare is absolutely essential and vital to America’s long-term prosperity. Starr provides an eye-opening account that paints a clear picture of the greed and extremist ideologies that sought to keep healthcare out of the reach of our poorest and most vulnerable citizens.

Paul Starr does an excellent job throughout the book of explaining the long history of healthcare reform and the huge efforts that contributed to it finally being passed. It is also worth noting that some will view this as a left-wing propaganda piece from a widely-known Democrat and former member of the Clinton administration. However, for those that go into this book with an open mind and a genuine willingness to learn more about the history of healthcare reform in America, there is much to be learned, and from an extremely experienced and qualified individual. When it comes to the Affordable Care Act (ACA), it comes as no surprise that Starr is a big supporter of the law. After all, he spent much of his own career fighting and working toward healthcare reform, and the ACA was largely inspired by the ideas Starr and his colleagues worked on during the Clinton years.

In conclusion, it is worth noting that Starr acknowledges that the ACA isn’t a perfect law, and it will require a lot of tweaking as any large policy change on a national level does. Starr also notes that the Affordable Care Act is designed to require states to cooperate, however, “Republican governors and legislators opposed the law, and Republican attorney generals filed suits challenging its constitutionality” (Starr 269).

That aside, Starr strongly supports universal healthcare, and believes that over the course of the next ten years, 32 million more Americans will have health coverage, and over time the cost of healthcare per person will drop even lower. It’s clear that although the Affordable Care Act isn’t perfect, it will undoubtedly end up benefitting and making a difference in the lives of millions upon millions of Americans. Under the law, more people will have healthcare coverage in the United States than ever before. People with pre-existing conditions will be covered (“About the Law”). Americans living in poverty will finally be able to get covered and have access to medical treatment. As Starr noted, there will be plenty of hiccups and glitches along the way, but the fact that Americans from all walks of life can finally have health coverage is a revolutionary step in the right direction.

Works Cited

“About the Law.” U.S. Department of Health and Human Services. n.p,. n.d. Web. 6 Nov. 2013.

Starr, Paul. Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. New Haven: Yale University Press, 2011. Print.