In The Transformation of American Health Insurance, Troyen A. Brennan traces the historical evolution of public and private health insurance in the United States from the first Blue Cross plans in the late 1930s to reforms under the Biden administration. In analyzing this evolution, he finds long-term trends that form the basis for his central argument: that employer-sponsored insurance is becoming unsustainably expensive, and Medicare for All will emerge as the sole source of health insurance over the next two decades.
After thirty years of leadership in health care and academia, Brennan argues that Medicare for All could act as a single-payer program or become a government-regulated program of competing health plans, like todays Medicare Advantage. The choice between these two options will depend on how private insurers adapt and behave in todays changing health policy environment.
This critical evolution in the system of financing health care is important to employers, health insurance executives, government officials, and health care providers who are grappling with difficult strategic choices. It is equally important to all Americans as they face an inscrutable health insurance system and wonder what the future might hold for them regarding affordable coverage.
Troyen A. Brennan is an adjunct professor of health policy and management at the Harvard T.H. Chan School of Public Health. He is a former professor of medicine at Harvard Medical School and the former chief medical officer at CVS Health. He is the author of Just Doctoring: Medical Ethics in the Liberal State and the coauthor of New Rules: Regulation, Markets, and the Quality of American Health Care.
Preface
Acknowledgments
1. Why Health Insurance Is Tied to Employment
2. What Do Health Insurers Do?
3. Health Care in the 1990s: To Manage or Not Manage Care
4. Twenty-First-Century Numbers
5. The Strange World of Pharmacy Commerce
6. The Commercial Parts of Medicare: Parts C and D
7. The Affordable Care Act: Presumption of Coverage Combined with a Regulated Market
8. Entering the 2020s
9. The Evolution of American Health Insurance: A Medicare Advantage for All Future
10. Medicare for All: A Single-Payer System
Notes
Index
th a Regulated Market 8. Entering the 2020s 9. Evolution of American Health Insurance: A Medicare Advantage for All Future 10. Medicare for All: Single Payer Notes Index
Can American health insurance survive?
Few, if any, health care experts can claim the enormous breadth of experience that Troy Brennan can. He tackles how to turn around our health care system with careful attention to the evidence, a scholars sense of balance, and a commitment to honesty. An instant must read for anyone who cares about finding our way to better health care.
— Don Berwick, Institute for Healthcare Improvement
Troyen Brennan is uniquely qualified to write a book explaining how American health care policy has evolved and where it might be going, having been at various times in his career a clinician and physician administrator, and an executive in health insurance, pharmacy benefit management, and retail pharmacy companies. You are sure to learn things about health policy you didnt know. This book has my strongest recommendation.
— Joseph P. Newhouse, Harvard University
Blending insights from a career in the top echelons of medicine, business, and academia, Brennans book is a must-read, exposing how US health insurance has produced a bloated healthcare system and why Medicare for All is not a liberal pipedream but a lifeboat that businesses will embrace.
— Leemore Dafny, Harvard University
A superb description of the government and commercial evolution of the uniquely American health financing, insurance, and delivery system. Troyen Brennan describes the inevitable financial and social trends pushing us toward a more equitable, effective health insurance system. The employer can be an important contributor to a value-based system to improve outcomes and reimbursement. If employers fail, then governments role may continue to expand, hopefully in public and private collaboration.
— Ron Williams, RW2 Enterprises, MIT, author of Learning to Lead
