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America's Bitter Pill
- Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System
- Narrated by: Dan Woren
- Length: 17 hrs and 10 mins
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Publisher's summary
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.
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
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Barack Obama’s inauguration as president on January 20, 2009, inspired the world. But the great promise of “Change We Can Believe In” was immediately tested by the threat of another Great Depression, a worsening war in Afghanistan, and an entrenched and deeply partisan system of business as usual in Washington. Despite all the coverage, the backstory of Obama’s historic first year in office has until now remained a mystery.
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Tiresome
- By Matthew on 05-21-10
By: Jonathan Alter
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Confidence Men
- Wall Street, Washington, and the Education of a President
- By: Ron Suskind
- Narrated by: James Lurie
- Length: 22 hrs
- Unabridged
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Performance
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Story
The hidden history of Wall Street and the White House comes down to a single American concept: confidence. Both centers of power, New York and Washington, learned how to manufacture it - until August 2007, when that confidence began to crumble. Ron Suskind here tells the story of what happened next, as Wall Street struggled to save itself while a man with little experience and soaring rhetoric emerged from obscurity to usher in "a new era of responsibility".
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Insightful, but...
- By Ray on 10-29-11
By: Ron Suskind
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Hostile Takeover
- Resisting Centralized Government's Stranglehold on America
- By: Matt Kibbe
- Narrated by: George Newbern
- Length: 12 hrs and 11 mins
- Unabridged
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Overall
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Performance
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Story
Hostile Takeover is a rebellious challenge to the "upper management" of government, who are choking American prosperity and liberty. Matt Kibbe exposes the privileged collusion of Washington insiders - and maps out a proven plan for how to return power from the self-appointed "experts" back to the people. Dubbed "one of the Tea Party's masterminds" by Newsweek, Kibbe reveals how grassroots citizens can and will check the federal behemoth and restore the American enterprise.
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An amazing book from an interesting perspective
- By Aaron on 12-28-12
By: Matt Kibbe
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Reinventing American Health Care
- How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System
- By: Ezekiel J. Emanuel
- Narrated by: William Dufris
- Length: 11 hrs and 57 mins
- Unabridged
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Performance
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Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who also served as a special adviser to the White House on health-care reform, has written a brilliant diagnostic explanation of why health care in America has become such a divisive social issue, how money and medicine have their own American story, and why reform has bedeviled presidents of the left and right for more than one hundred years.
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The book lacks integrity
- By Richard M. Shaner on 06-02-16
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Get What's Yours for Medicare
- Maximize Your Coverage, Minimize Your Costs
- By: Philip Moeller
- Narrated by: James Foster
- Length: 7 hrs and 27 mins
- Unabridged
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Overall
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Performance
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A coauthor of the New York Times bestselling guide to Social Security Get What's Yours authors an essential companion to explain Medicare, the nation's other major benefit for older Americans. Learn how to maximize your health coverage and save money.
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Very Negative and Overwhelming
- By A.C.W. on 04-08-20
By: Philip Moeller
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Armageddon
- How Trump Can Beat Hillary
- By: Dick Morris, Eileen McGann
- Narrated by: Ian Patterson
- Length: 8 hrs and 45 mins
- Unabridged
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Overall
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Performance
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Story
Timed for the critical presidential election season, New York Times best-selling author and noted political commentator Dick Morris provides a strategy and position on the issues for Republicans to attract crucial new voters to the party in order to win back the White House in 2016 and put an end to the Obama agenda of ruinous socialism. By using new issues, attracting new voters, and offering new alternatives, Republicans can win the election of 2016 and save America!
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Informative and practical a must read
- By quentin on 06-30-16
By: Dick Morris, and others
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Class Warfare
- Inside the Fight to Fix America's Schools
- By: Steven Brill
- Narrated by: L. J. Ganser
- Length: 16 hrs
- Unabridged
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Overall
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Performance
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Story
In a reporting tour de force, award-winning journalist Steven Brill takes an uncompromising look at the adults who are fighting over America’s failure to educate its children and points the way to reversing that failure. Brill not only takes us inside their roller-coaster battles, he also concludes with a surprising prescription for what it will take from both sides to put the American dream back in America’s schools.
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Unions are Evil
- By Elton on 09-16-11
By: Steven Brill
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Nothing to Fear
- FDR's Inner Circle and the Hundred Days That Created Modern America
- By: Adam Cohen
- Narrated by: Norman Dietz
- Length: 14 hrs and 10 mins
- Unabridged
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Overall
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Performance
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Story
Nothing to Fear brings to life a fulcrum moment in American history - the tense, feverish first 100 days of Franklin Delano Roosevelt's presidency, when he and his inner circle completely reinvented the role of the federal government.
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Important contribution
- By R.S. on 03-05-09
By: Adam Cohen
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Detroit Resurrected
- To Bankruptcy and Back
- By: Nathan Bomey
- Narrated by: Jonathan Yen
- Length: 9 hrs and 31 mins
- Unabridged
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Overall
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Performance
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Story
From thriving Motor City to the largest municipal bankruptcy in American history, Detroit has become the nation's cautionary tale. But what led to the fateful day of the filing, and how did the city survive this crisis? Journalist Nathan Bomey delivers the inside story of Detroit's decline and the people who fought to save it against impossible odds: Governor Rick Snyder, a self-proclaimed nerd; emergency manager Kevyn Orr, a lawyer with singular dedication; Judge Steven Rhodes, the city's conscience; and retirees who fought to ensure that Detroit kept its promises.
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Outsiders Perspective
- By Carl on 02-07-17
By: Nathan Bomey
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The Best Worst President
- What the Right Gets Wrong About Barack Obama
- By: Mark Hannah
- Narrated by: Kaleo Griffith
- Length: 7 hrs and 56 mins
- Unabridged
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Overall
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Performance
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Story
Political analyst and Democratic campaign veteran Mark Hannah gives Barack Obama the victory lap he deserves in this compendium that takes the president's critics head-on and celebrates the president's many underappreciated triumphs.
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Thought-provoking
- By Jean on 07-11-16
By: Mark Hannah
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Outsider in the White House
- Special Audio Edition
- By: Bernie Sanders, Huck Gutman, John Nichols - afterword
- Narrated by: Joe Barrett, Brian Sutherland
- Length: 10 hrs and 5 mins
- Unabridged
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Overall
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Performance
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Story
Bernie Sanders' campaign for the presidency of the United States has galvanized supporters all over the country, drawing attention to issues of economic, racial, and social justice and spotlighting one of the most interesting and unconventional candidates in decades.
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Behind the Scenes with Bernie--- WORTH it!
- By Susie on 02-23-16
By: Bernie Sanders, and others
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Very important book!
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Not well balanced
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Tailspin
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In this revelatory narrative covering the years 1967 to 2017, Steven Brill gives us a stunningly cogent picture of the broken system at the heart of our society. He shows us how, over the last half-century, America's core values - meritocracy, innovation, due process, free speech, and even democracy itself - have somehow managed to power its decline into dysfunction.
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Shorter would have been Better
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Sickening
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The United States spends an excess $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks a lowly 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals.
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Great info, but I’m confused…
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The Social Transformation of American Medicine
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Considered the definitive history of the American healthcare system, The Social Transformation of American Medicine examines how the roles of doctors, hospitals, health plans, and government programs have evolved over the last two and a half centuries. Updated with a new preface and an epilogue analyzing developments since the early 1980s, this new edition is a must-listen for anyone concerned about the future of our fraught healthcare system.
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Fascinating Survey of Healthcare in Amerixa
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The American Health Care Paradox
- Why Spending More Is Getting Us Less
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In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of health care, archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They tell us how, and why, the US health care system developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.
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great book and points
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By: Elizabeth H. Bradley, and others
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Very important book!
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Not well balanced
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Shorter would have been Better
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The United States spends an excess $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks a lowly 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals.
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Great info, but I’m confused…
- By Iread on 04-04-22
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The Social Transformation of American Medicine
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great book and points
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Dr. Zeev Neuwirth wrote Reframing Healthcare for leaders and organizations interested in understanding what the disrupters in healthcare are doing and, more to the point, for those who want to be the disrupters rather than the disrupted. This audiobook is a step-by-step guide for leadership teams that are intent on improving healthcare at an accelerated pace. It’s written for healthcare organizations that wish to thrive in a customer-centric, community-oriented, value-based healthcare system.
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Great content and resources
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Unaccountable
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Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's best-selling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting. Over the last 10 years, neither error rates nor costs have come down, despite scientific progress.
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Everyone should read this book.
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Priced Out
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Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of today's US health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it.
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A great book for someone who studies healthcare and economics
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By: Uwe E. Reinhardt, and others
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For Blood and Money
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For Blood and Money tells the little-known story of how an upstart biotechnology company created a one-in-a-million cancer drug and how the core team—denied their share of the profits—went and did it again. In this epic saga of money and science, veteran financial journalist Nathan Vardi explains how the invention of two of the biggest cancer drugs in history became (for their backers) two of the greatest Wall Street bets of all time.
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Must-read for biotech enthusiasts and scientists
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Class Warfare
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In a reporting tour de force, award-winning journalist Steven Brill takes an uncompromising look at the adults who are fighting over America’s failure to educate its children and points the way to reversing that failure. Brill not only takes us inside their roller-coaster battles, he also concludes with a surprising prescription for what it will take from both sides to put the American dream back in America’s schools.
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Unions are Evil
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Bad Pharma
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Medicine is broken. We like to imagine that it's based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry.
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A must read for health professionals
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Bottle of Lies
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From an award-winning Fortune reporter, an explosive narrative investigation of the generic drug boom that reveals the life-threatening dangers posed by globalization - The Jungle for pharmaceuticals.
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overbearing self-righteous indignation
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After
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After is an astounding, inspiring, and exciting account of America in the first year of the September 12 era. Based on 347 on-the-record interviews and revelations from memos of government meetings, court filings, and other documents, award-winning journalist Steven Brill takes us inside the critical dramas of the year after the September 11 attacks, from the Justice Department's drive to find terror cells to Congress's decision to bail out the airline industry.
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New Material---Worth Hearing
- By G Barth on 04-07-05
By: Steven Brill
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The Truth About the Drug Companies
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Overall
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Performance
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Story
In this explosive expose of the drug companies and how they are ripping us off, Marcia Angell, M.D., a doctor, medical journalist, and a former editor of the respected New England Journal of Medicine, reveals the many ways in which the pharmaceutical industry has moved away from its original purpose of finding and producing useful new drugs.
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Pronunciation
- By Greg on 05-22-07
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The Long Fix
- Solving America's Health Care Crisis with Strategies That Work for Everyone
- By: Vivian Lee
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- Unabridged
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Overall
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Performance
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Story
In The Long Fix, physician and health-care CEO Vivian S. Lee, MD, cuts to the heart of the health-care crisis. The problem with the way medicine is practiced, she explains, is not so much who's paying, it's what we are paying for. Insurers, employers, the government, and individuals pay for every procedure, prescription, and lab test, whether or not it makes us better - and that is both backward and dangerous.
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Unsatisfactory narration
- By Sara K on 10-16-20
By: Vivian Lee
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The Hidden History of the Supreme Court and the Betrayal of America
- The Thom Hartmann Hidden History Series
- By: Thom Hartmann
- Narrated by: Sean Pratt
- Length: 4 hrs and 15 mins
- Unabridged
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Overall
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Performance
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Story
Taking his typically in-depth, historically informed view, Thom Hartmann asks: What if the Supreme Court didn't have the power to strike down laws? According to the Constitution, it doesn't. From the founding of the republic until 1803, the Supreme Court was the final court of appeals, as it was always meant to be. So where did the concept of judicial review start? As so much of modern American history, it began with the battle between the Federalists and Anti-Federalists, and with Marbury v. Madison.
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A must read to understand why voting is essential.
- By Brandon WIlliams on 10-05-19
By: Thom Hartmann
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Pharma
- Greed, Lies, and the Poisoning of America
- By: Gerald Posner
- Narrated by: Jacques Roy
- Length: 22 hrs and 55 mins
- Unabridged
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Overall
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Performance
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Story
Pharmaceutical breakthroughs such as antibiotics and vaccines rank among some of the greatest advancements in human history. Yet, exorbitant prices for life-saving drugs, safety recalls affecting tens of millions of Americans, and soaring rates of addiction and overdose on prescription opioids have caused many to lose faith in drug companies. Now, Americans are demanding a national reckoning with a monolithic industry.
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Great book, but with some issues
- By Irina on 06-12-20
By: Gerald Posner
What listeners say about America's Bitter Pill
Average customer ratingsReviews - Please select the tabs below to change the source of reviews.
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- Andrew S. Breza
- 01-14-15
Great history, questionable solutions
Steven Brill offers the most complete history to date of the roll out of the Affordable Care Act (Obamacare). He gives a behind the scenes perspective that spares no one, be it Congressional Democrats who passed the ACA using back room deals, Republicans who opposed the law without offering an alternative, or the leaderless and bumbling effort by the Obama administration to implement health insurance exchanges. The book gives a solid, albeit opinionated, history until its end, where Brill steps out of his role as historian to speculate about how he would fix America's healthcare system if given the power. His prescriptions for success are interesting but unconvincing, giving an otherwise impressive bit of modern history a tepid coda.
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18 people found this helpful
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- audrey s
- 05-14-15
Good facts but sometimes one sided conclusions
It had some good information although not particularly revelatory if you were at all politically aware during the implementation of the ACA. Personally I feel the author did every sort of logical (or non-logical) mental gymnastics to come to the conclusion that is spite of all of the problems with its passage and implementation, the country is better off because of the ACA , and now all we have to do is pass more regulations through, for example, the FTC so that we really fix health care for good. I tried to keep an open mind during this story but still come to the opposite conclusion. In spite of the authors attempt to convince me otherwise, I think the ACA is and will make America worse off in the long run. Regardless of my opinion about the ACA,
the book itself was decent.
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17 people found this helpful
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- Joseph
- 02-28-15
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.
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14 people found this helpful
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- Pete
- 04-18-17
"In Defense of the ACA" is a more appropiate title
Would you try another book from Steven Brill and/or Dan Woren?
Steven Brill - No
Dan Woren - Yes
Would you ever listen to anything by Steven Brill again?
No
Any additional comments?
Completely biased analysis. Author is incapable of lending a serious critical eye on the shortcomings of the ACA and where it desperately needs improvement. The author focuses on a handful of cases where patients benefitted from the act while completely ignoring those negatively impacted.
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9 people found this helpful
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- DaWoolf
- 03-02-15
The agony and ecstasy of Obamacare
Steven Brill provides a critical analysis of the development and implementation of the Affordable Care Act (ACA). Brill starts with the 2008 Democratic Primary, where Barak Obama seemed underprepared to provide a substitutive healthcare plan compared to Hillary Clinton. Recognizing his short-comings, Obama launches himself into the issue that will serve to define his legacy. Brill provides the details on the political deals, players, compromises, and negotiations that allowed the ACA to become law.
Brill does an expert job to describing the ACA registration rollout fiasco and the herculean efforts needed to create a functional enrollment website under immense political pressure. There are also numerous stories of ordinary people with significant health conditions and how they were affected by the ACA.
The problem with America’s Bitter Pill (ABP) is the big take away, although universal health coverage is terrific the ACA lacks the regulations to contain consumer costs. This issue is due to the fact that the ACA was written to protect the financial interests of insurance providers, hospitals, pharmaceutical companies and medical equipment suppliers. ABP reminded me of Otto von Bismarck’s famously stated quote “Laws are like sausages, it is better not to see them being made.”
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- Robert B.
- 06-26-19
"one biased persons opinion on healthcare stuff"
is what it should have been titled. the author demonstrates the ability to hold two conflicting views at the same time: at once chronicaling the federal government's near complete failure to execute on something as simple as a website and at the same time extolling the virtues of government run healthcare. at the same time vilifying private sector business, he notes that only when private sector business people got involved was the debacle saved. the degree to which his opinions on the pharmaceutical industry and hospital charges were I'll informed causes me to call into question his claims in other areas. I'll never get that time back.
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- Kate M.
- 05-24-15
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.
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- James
- 02-13-15
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.
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- Customer in DC
- 03-24-15
Fascinating, insightful, and entertaining
I rarely do book reviews. As former Hill staff close to this topic, I completely enjoyed the behind the door stories, easily digestible yet compelling data, and hopeful suggestions at the end. I highly recommend everyone having any strong views on this topic first read this book and reexamine one's, including my, probably limited understanding. Last but importantly, this book is long but highly entertaining.
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- Cindy Cooper
- 02-07-18
For those who want to know
Excellent documentation for those who want to know how we got where we are with healthcare in the U.S.
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