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. Praise for America’s Bitter Pill “An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Brill] has pulled off something extraordinary.” —The New York Times Book Review “A thunderous indictment of what Brill refers to as the ‘toxicity of our profiteer-dominated healthcare system.’ ” — Los Angeles Times “A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform.” — The Daily Beast “One of the most important books of our time.” —Walter Isaacson “Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system.” — The New York Review of Books

The competition for limited health care resources is intensifying. We urgently need an acceptable method for deciding how they should be allocated. But the goods that health care produces are of very different kinds. Health care can extend the lives of children and of older people. It can make it possible for a person to walk, when without health care that person would be permanently bedridden; and it can reduce the pain and distress of people who are terminally ill. How can we possibly decide which of these - and many more - diverse achievements of health care are more deserving than others? We need a common unit by which we might be able to measure these very different goods. The Quality-Adjusted Life Year, or QALY, is the most developed proposal for such a unit of measure. In this book a distinguished team of ethicists and economists defend the core of the QALY proposal: that health care resources should be used so as to produce more years of life, of the highest possible quality. This leads to a discussion of such fundamental questions as whether all lives are of equal value, whether health care should be allocated on the basis of need and whether the QALY approach incorporates an adequate account of fairness or justice. The result is the most thorough account yet of the ethical issues raised by the use of the QALY as a basis for allocating health care resources.

From Publishers Weekly In this "striking portrait" of Pittsburgh's prominent Children's Hospital, the author argues that the young receive superior care in institutions devoted solely to them. "Employing a journalist's 'fly on the wall' strengths of observation, rendering insights with novelistic verve, Gutkind recounts hospital procedures . . . and chronicles a procession of tragedies and triumphs," said PW. Copyright 1991 Reed Business Information, Inc.