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American Healthcare from Johnson to Trump

Explains the mess we're in

Written for nonexperts, this is a brisk, engaging history of American healthcare from the advent of Medicare and Medicaid in the 1960s to the impact of the Affordable Care Act in the 2010s. Step by step, Jonathan Engel shows how we arrived at our present convoluted situation, where generic drugs prices can jump 1,000 percent in a day and primary care physicians can lose 20 percent of their income at the stroke of a Congressional pen.

Unaffordable covers, in a conversational style punctuated by apt examples, topics ranging from health insurance, pharmaceutical pricing, and physician training to health maintenance organizations and hospital networks. Along the way, Engel introduces approaches that other nations have taken in organizing and paying for healthcare and offers insights on ethical quandaries around end-of-life decisions, neonatal care, life-sustaining treatments, and the limits of our ability to define death. While describing the political origins of many of the federal and state laws that govern our healthcare system today, he never loses sight of the impact that healthcare delivery has on our wallets and on the balance sheets of hospitals, doctors' offices, government agencies, and private companies.


Jonathan EngelJonathan Engel is the author of American Therapy; Poor People's Medicine; Doctors and Reformers; and The Epidemic: A History of AIDS. He is a professor in the School of Public Affairs at Baruch College and an adjunct professor of health policy and management at the Mailman School of Public Health, Columbia University.



“The book, which is written in an accessible manner, is a good companion for readers with limited familiarity about how health care is paid for and delivered.”
Bulletin of the History of Medicine

“Engel's clear storyline and simple (but not simplistic) analysis make sense of a topic of mind-boggling complexity. Invaluable.”
—David Herzberg, author of Happy Pills in America

“A comprehensive, readable, balanced examination of the costs of the crazy quilt healthcare 'system' that has evolved in the United States over five decades.”
—Ronald L. Numbers, coeditor of Sickness and Health in America

“Even-handed, critical assessments of the economics and ethics of successive efforts at health reform. It ought to be required reading, providing an essential dose of humility to any policymaker or pundit contemplating health care reform.”
—Sherry Glied, New York University


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Of Related Interest


Wisconsin and the Shaping of American Law
Joseph A. Ranney


The Rise and Fall of HMOs
An American Health Care Revolution
Jan Gregoire Coombs


Larger images

February, 2018
LC: 2017015526 RA
296 pp. 6 x 9

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Cloth $34.95 a
ISBN 978-0-299-31410-1
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