Crossing the American Health Care Chasm

Why is there such a deep partisan division within the United States regarding how health care should be organized and financed—and how can we encourage politicians to band together again for the good of everyone?

For decades, Democratic and Republican political leaders have disagreed about the fundamental goals of American health policy. The modern-day consequences of this disagreement—particularly in the Republicans' campaign to erode the coverage and equity gains of the Affordable Care Act—can be seen in the tragic and disparate impact of COVID-19 on the country. In Crossing the American Health Care Chasm, Donald A. Barr, MD, PhD, details the breakdown in political relations in the United States. Why, he asks, has health policy—which used to be a place where the two sides could find common ground—become the nexus of fiery political conflict?

From Harry S. Truman's failed attempt to enact a plan for national health insurance to the recent efforts of President Donald J. Trump, Barr's historical analysis also touches on every presidential administration in between. Tracing the bipartisanship that developed over the four decades following the passage of Medicare and Medicaid in 1965, Barr explains why this spirit of cooperation has given way to such a seemingly unbridgeable ideological chasm. Exploring how political conflict affects health care organization, financing, and delivery, Barr also offers a detailed analysis of the multiple attempts on the part of congressional Republicans and the Trump administration either to weaken or to repeal the ACA. Crossing the American Health Care Chasm offers a series of steps that policy makers can take to improve the national health care situation and provide a basis for ongoing bipartisanship as we continue to confront the policy challenges facing our country.

Ultimately, Barr argues, this divide is more dangerous than ever at a time when health care costs continue to skyrocket, the number of uninsured Americans is rising, many state governments are chipping away at Medicaid, and the GOP has not let up in its efforts to dismantle the ACA. This book will be of profound interest both to those responsible for carrying out national health care policy and to those who study health policy from an academic perspective.