Roberta E. Winter. Unraveling U.S. Health Care: A Personal Guide. Lanham, MD: Rowman & Littlefield Publishers, Inc. $29.99. 289 pp. Hardback. ISBN: 9781442222977

AuthorDaniel Skinner
Published date01 June 2015
Date01 June 2015
Book Review
Roberta E. Winter. Unraveling U.S. Health Care: A Personal Guide. Lanham, MD:
Rowman & Littlef‌ield Publishers, Inc. $29.99. 289 pp. Hardback. ISBN:
Those who have perused the Patient Protection and Affordable Care Act
(ACA) will know that Congress attached a brief glossary of terms that def‌ines
some of the legislation’s most commonly used terminology. This glossary is
intended, among other things, to make the complicated and often convoluted
world of health policy palatable. Despite these attempts, the bill—with its many
moving parts—is often elusive, even to health policy scholars. For better or worse,
Americans have opted to eschew the simpler, and often more effective “single-
payer” approach undertaken by most Western democracies.
The price of this
decision is complexity.
In Unraveling U.S. Health Care, Roberta E. Winter seeks to help readers
navigate this complexity. Unlike many books about health-care reform, Winter
does not revisit pre-ACA policy history or examine ACA politics. Rather, her
book is, as advertised, “A Personal Guide” of the most practical sort. The text is
divided into four main parts. The f‌irst provides an overview of American health
care with special attention to the question, “why does this matter to me?” (p. 10).
Winter argues that the private health system is “bifurcated” (p. 11). In large part
this is because “health care providers make money based on the volume of
services, so it is to their advantage to provide more services per paying patient,
not less” (p. 17), while patients often actually benef‌it—f‌inancially and in their
health outcomes—from lower intensity care. The cornerstone of this part is a
direct comparison with other highly industrialized countries in which the
American health system comes up short in virtually every category—except for
cost, a category in which the United States is unrivaled. Part Two, “Health Care
Quality: Know Where to Go,” is prof‌itable reading for those seeking a
comprehensive list of the best hospital performances in quality and merit. Winter
recommends a “culture of transparency” (p. 47) that has historically not existed in
American hospitals, but would ensure that hospitals and doctors are obliged to
provide increasingly honest and quality care. Part Three addresses a potpourri of
World Medical & Health Policy, Vol. 7, No. 2, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

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