Medicaid, America’s government-run health insurance program for the poor, should be a lifeline that provides needed health care to Americans with no other options. Surprisingly, however, it doesn’t. The medical literature reveals a $450 billion-a-year scandal: that people on Medicaid have far worse health outcomes than those with private insurance, and no better outcomes than those with no insurance at all. Why is this so? In How Medicaid Fails the Poor, Avik Roy explains how Medicaid’s clumsy design and perverse incentives make it hard for people on Medicaid to get the medical care they need. Medicaid doesn’t reimburse doctors or hospitals for the cost of caring for Medicaid enrollees, forcing many doctors to opt out of the program. The Affordable Care Act, otherwise known as Obamacare, doubles down on this broken system. Roy shows us that there are better ways, using private insurance, to provide needed care to our poorest citizens.

“A provocative examination of our health care delivery for the poor. . . . Such an honest and candid account is essential.” —Alex Kotlowitz, national bestselling author of There Are No Children Here Mama Might Be Better Off Dead immerses readers in the lives of four generations of a poor, African-American family from North Lawndale, Chicago, who are beset with the devastating illnesses that are all too common in America’s inner-cities. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Laurie Kaye Abraham chronicles their access—or lack thereof—to medical care. Their story reveals an inadequate health care system that is further undermined by the effects of poverty. Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care in America. This new edition includes an incisive foreword by David Ansell, a physician who worked at Mt. Sinai Hospital, where much of the Banes family’s narrative unfolds. “Goes to the heart of today’s problem. Powerful . . . deeply searching.” —Washington Post “A powerful indictment of the big business of medicine.” —Los Angeles Times “Abraham . . . illuminates the problems with passion and skill.” —Kirkus Reviews “This personally observed, lucid chronicle and call for reform of our ailing health system covers all levels of responsibility in the medical establishment.” —Publishers Weekly “Clearly identifies in human and policy terms how [healthcare] programs have failed a population desperately in need of help.” —Library Journal

American health care is at a crossroads. Health spending reached $3.5 trillion in 2017. Yet more than 27 million people remain uninsured. And it's unclear if all that spending is buying higher-quality care. Patients, doctors, insurers, and the government acknowledge that the healthcare status quo is unsustainable. America's last attempt at health reform -- Obamacare -- didn't work. Nearly a decade after its passage in 2010, Democrats are calling for a government takeover of the nation's healthcare system -- Medicare for All. The idea's supporters assert that health care is a right. They promise generous, universal, high-quality care to all Americans, with no referrals, copays, deductibles, or coinsurance. With a sales pitch like that, it's no wonder that seven in ten people now support Medicare for All. Doctors, especially young ones, are coming around to the idea of single-payer, too. Democrats, led by the progressive wing of the party, hope to capitalize on this enthusiasm. In 2017, they introduced companion legislation in the House and Senate that would establish Medicare for All. They have already promised to do the same when the next Congress convenes in 2019. More than 70 House Democrats have joined a new Medicare for All Caucus. Senator Bernie Sanders is effectively already on the presidential campaign trail, making his case for single-payer. If Democrats take the White House and Senate in 2020, and hold onto the House, a Medicare for All bill could be among the first pieces of legislation presented to the new president for a signature. In this book, Sally C. Pipes, a Canadian native, will make the case against Medicare for All. She'll explain why health care is not a right -- and how progressives pressing for single-payer are making a litany of promises they can't possibly keep. Evidence from government-run systems in Canada, the United Kingdom, and other developed countries proves that single-payer forces patients to withstand long waits for poor care at high cost. First, she'll unpack the Medicare for All plans under consideration in Congress. She'll explain how radical they truly are. Medicare for All will not save $5 trillion, as some of its proponents claim. It will cost about $32 trillion over 10 years, according to analyses from the Urban Institute and the Mercatus Center. It will outlaw private health insurance. It will raise taxes by trillions of dollars. It will cut pay for doctors to the rates paid by Medicare and thereby exacerbate our nation's shortage of physicians. And it will ration care. Then, Sally will detail the horrors of single-payer. She'll start in Canada, whose single-payer system most closely resembles the one progressives have in mind for the United States. Analyses of the government-run systems in the United Kingdom and a few other developed countries will follow, with particular focus on the problems that these systems pose for patients and doctors. To substantiate her indictment of single-payer, Sally will marshal both quantitative and qualitative evidence. She'll highlight how Americans fare better than their peers in Canada and the United Kingdom on the health outcomes that are directly linked to the quality of a healthcare system, including survival rates for patients with cancer and cardiovascular issues. She'll also explain why the health outcomes where the United States performs poorly relative to other nations, like infant mortality and life expectancy, tell us little about our healthcare system. Sally will pepper her text with heart-wrenching stories of the human costs of single-payer -- of people who were injured, were forced to remain in pain, or even died because their government-run healthcare system delayed or denied care. Too often, evangelists for free markets limit their arguments to facts and statistics -- and fail to appeal to the public's emotions. Sally will feature the stories of individuals and families who have been victims of single-payer systems. These vignettes will help drive home the truth about single-payer -- and why it must not come to the United States. She'll conclude with her vision for delivering the affordable, accessible, quality care the American people are looking for.

WINNER: The 2019 Lillian Smith Book Award, 2018 McGannon Center Book Prize, and shortlisted for the Goddard Riverside Stephan Russo Book Prize for Social Justice Astra Taylor, author of The People's Platform: "The single most important book about technology you will read this year." Dorothy Roberts, author of Killing the Black Body: "A must-read." A powerful investigative look at data-based discrimination?and how technology affects civil and human rights and economic equity The State of Indiana denies one million applications for healthcare, foodstamps and cash benefits in three years—because a new computer system interprets any mistake as “failure to cooperate.” In Los Angeles, an algorithm calculates the comparative vulnerability of tens of thousands of homeless people in order to prioritize them for an inadequate pool of housing resources. In Pittsburgh, a child welfare agency uses a statistical model to try to predict which children might be future victims of abuse or neglect. Since the dawn of the digital age, decision-making in finance, employment, politics, health and human services has undergone revolutionary change. Today, automated systems—rather than humans—control which neighborhoods get policed, which families attain needed resources, and who is investigated for fraud. While we all live under this new regime of data, the most invasive and punitive systems are aimed at the poor. In Automating Inequality, Virginia Eubanks systematically investigates the impacts of data mining, policy algorithms, and predictive risk models on poor and working-class people in America. The book is full of heart-wrenching and eye-opening stories, from a woman in Indiana whose benefits are literally cut off as she lays dying to a family in Pennsylvania in daily fear of losing their daughter because they fit a certain statistical profile. The U.S. has always used its most cutting-edge science and technology to contain, investigate, discipline and punish the destitute. Like the county poorhouse and scientific charity before them, digital tracking and automated decision-making hide poverty from the middle-class public and give the nation the ethical distance it needs to make inhumane choices: which families get food and which starve, who has housing and who remains homeless, and which families are broken up by the state. In the process, they weaken democracy and betray our most cherished national values. This deeply researched and passionate book could not be more timely.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Millions of low-income African Americans in the United States lack access to health care. How do they treat their health care problems? In Health Care Off the Books, Danielle T. Raudenbush provides an answer that challenges public perceptions and prior scholarly work. Informed by three and a half years of fieldwork in a public housing development, Raudenbush shows how residents who face obstacles to health care gain access to pharmaceutical drugs, medical equipment, physician reference manuals, and insurance cards by mobilizing social networks that include not only their neighbors but also local physicians. However, membership in these social networks is not universal, and some residents are forced to turn to a robust street market to obtain medicine. For others, health problems simply go untreated. Raudenbush reconceptualizes U.S. health care as a formal-informal hybrid system and explains why many residents who do have access to health services also turn to informal strategies to treat their health problems. While the practices described in the book may at times be beneficial to people’s health, they also have the potential to do serious harm. By understanding this hybrid system, we can evaluate its effects and gain new insight into the sources of social and racial disparities in health outcomes.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.