Kirsch R. Fighting For Our Health. The Rockefeller Institute Press 2012, 416 pages, $19.95.
Fighting For Our Health provides a left-sided perspective on the processes and powers that led to the passage of the Patient Protection and Affordable Care Act in March of 2010. The author is neither an academic nor a health care provider. He has spent much of his recent career working with an advocacy organization called Health Care for America Now that is headquartered on K street in Washington, D.C., backed by a coalition which includes grass roots support, powerful unions, and wealthy backers.
The author’s background and experience is a central theme of this tome. At times this is as much about him as it is about healthcare, which is both good and bad. On the positive side of the ledger, he provides a passionate and at times humorous perspective on the state of US politics, from the vantage point of those who were working to influence the President and the 111th Congress in the 2009-2010 time period.
Be forewarned, however, that this is not a heavily referenced, even-handed, professorial analysis of the kind that we expect from academics or consulting gurus. The villains in his story are for the most part the insurance companies and their allies, a position with which many physicians will likely concur. In the book, physicians (at least the primary care doctors) are generally treated sympathetically when they are mentioned. The work’s focus is on politics and corporations and the advocacy itself rather than its implications for those of us who work in the field. That should be troubling to many of the readers of the AJNR, since the solutions Mr. Kirsch has fought so hard for will have serious and probably very negative consequences for specialists and specialties like ours.
The book’s greatest strength is that it takes you on the journey with him as the process unfolds. You don’t have to be a political junkie to become involved in this story of how advocacy gets done. The book contains many fascinating details on a range of issues, from forming alliances to coordinating messaging and generating influence. Kirsch is not shy about taking sides and naming names. As the action plays out, he discusses how the votes were toted up in Congress to push the bill through. There is remarkable insight available in this book all the way down to the granular detail on how organizations like his work to mobilize the citizenry and to create change in America. There are lessons for physicians here and an opportunity for us to understand how perception is shaped.
Those who are looking for a definitive analysis of how we got health reform and how it will affect neuroradiologists should look elsewhere. This is a partisan book that will certainly appeal to the choir, in this case, those on the left who agree with the author that the White House did not go far enough with health reform in 2010. It may not please folks elsewhere on the political spectrum, but all readers would benefit from deriving greater insights into how political action really gets done in the US, both inside and outside of the government.