America's Bitter Pill

Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System

By: Steven Brill

Narrated by: Dan Woren

NEW YORK TIMES BESTSELLER • A NEW YORK TIMES NOTABLE BOOK • “A tour de force . . . a comprehensive and suitably furious guide to the political landscape of American healthcare . . . persuasive, shocking.”—The New York Times

America’s Bitter Pill is Steven Brill’s acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry. It’s a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America’s largest, most dysfunctional industry. It’s a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time magazine cover story continues, despite Obamacare. And it is the first complete, inside account of how President Obama persevered to push through the law, but then failed to deal with the staff incompetence and turf wars that crippled its implementation.

But by chance America’s Bitter Pill ends up being much more—because as Brill was completing this book, he had to undergo urgent open-heart surgery. Thus, this also becomes the story of how one patient who thinks he knows everything about healthcare “policy” rethinks it from a hospital gurney—and combines that insight with his brilliant reporting. The result: a surprising new vision of how we can fix American healthcare so that it stops draining the bank accounts of our families and our businesses, and the federal treasury.

©2015 Steven Brill (P)2015 Random House Audio

Critic reviews

“An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Steven Brill] has pulled off something extraordinary—a thriller about market structure, government organization and billing practices.”—The New York Times Book Review

“A thunderous indictment of what Brill refers to as the ‘toxicity of our profiteer-dominated healthcare system’ . . . For its insights into our nation’s fiscal, psychological and corporeal health—and for our own long-term social well-being—it is a book that deserves to be read and discussed widely by anyone interested in the politics and policy of healthcare.”—Los Angeles Times

“A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform . . . [Brill’s] book brims with unconventional insight delivered in prose completely uninfected by the worn out tropes and tired lingo of the Sunday shows.”—The Daily Beast

Best Non-Fiction since Game Change

I read on average two books each week. Steven's brilliant style, clever approach and direct questioning is the heart of a book that should be part of the curriculum in high school civics/social studies classes. Truly enthralled with this work. Don't miss this because it effects everyone going forward for decades to come.

Messed up Health Care System

I liked the story, although I'm not sure I agree with the author's proposed solutions, but found it frustrating that our system is so messed up.

Well researched

History on why US healthcare sucks

Very good and very interesting- overwhelming detail on why politics is the plague of government

Great initial read on Healthcare problems

Provided overview and insights into current situation and the political aspects that need to be addressed

So informative

This book ought to be required reading to be a US citizen (and registered voter)...

Everyone should read this

I don't even want to talk with you about healthcare reform in American unless you have read this book.

informative and well read

filled with great facts. presented in highly entertaining form. highly recommend for anyone trying to understand the ACA.

Why health care in the United States doesn’t work.

This well written and extensively researched book shines a bright light on the extent of the GREED in our prescription drug prices in this country. A massive redistribution of wealth and the reinforcement of the have’s verses the have nots is in very clear focus.

Must read/listen

As a generalist physician who has spent the last 35 years inside the system, the exposure of the true guts of the system, was elucidating and disquieting. For administrators of this system to be paid so much more than those who actually deliver the care is disquieting too. Incentives are displaced badly.
I do not know if Brill's suggestions at the end of the book would work, but they would allow true market forces to work on efficiency and competence.
I finished the book enlightened and discouraged about the future of my profession.

An Important Book for Everyone

Would you listen to America's Bitter Pill again? Why?

No--I do not listen to books more than once. I have too many that I still need to get to!

What was one of the most memorable moments of America's Bitter Pill?

There were so many unbelievable scenarios and anecdotes in this book that I found myself constantly amazed by what I did not know until I listened to the book. One that stands out is a man who had pneumonia and was hit with a $143,000 lab bill from the hospital for which he was personally responsible. Or the previously uninsured woman who had significant health issues but could not afford her medication. The author suggested that she look into her state's new insurance exchange and she said that she would never get "Obamacare" because her political representatives said that it was bad and would not cover current illness. She did get insurance through her state exchange (she did not realize that it was possible because it was "Obamacare") and then got her heart disease and diabetes under control.

Which character – as performed by Dan Woren – was your favorite?

Steve Beshear, the governor of Kentucky, got on the band wagon early and set up Kynect, KY's health exchange. KY is one of the worst states for health outcomes and issues. This exchange was created under budget, on time, and was working when the federal exchanges did not.
I also enjoyed that Mitch McConnell, the representative from KY, finally said he liked Kynect but not Obamacare--not explaining to his constituents that they are the same thing!

Did you have an extreme reaction to this book? Did it make you laugh or cry?

This is a brilliant book which caused me to experience many emotions--mostly frustration and incredulity, and a few laughs at the craziness of the political struggles. The absolute vitriol leveled by all sides of the debate (there were many sides) was so disgusting that I had to laugh.

Any additional comments?

In addition to understanding the difficult birth and life of the Affordable Care Act, I found that I learned even more about the medical and insurance industries pre-Act. I have always had good insurance so never really paid attention to what was going on behind the scenes. Brill has done an outstanding job in making this complex issue understandable and interesting.