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

• Author: Daniel Skinner
• DOI: http://doi.org/10.1002/wmh3.144
• Published date: 01 June 2015
• Date: 01 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:

9781442222977

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.

1

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

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1948-4682 #2015 Policy Studies Organization

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