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Hardcover | $21.95 Trade | £15.95 | ISBN: 9780262014076 | 192 pp. | 6 x 9 in | February 2010
Paperback | $11.95 Trade | £9.95 | ISBN: 9780262517256 | 192 pp. | 6 x 9 in | February 2012

Essential Info

Health Care Turning Point

Why Single Payer Won't Work


The battle over health care reform has reached a turning point. We can try to fashion new policies based on old ideas—or we can acknowledge today's demographic and economic realities. In Health Care Turning Point, health policy expert Roger Battistella argues that the conventional wisdom that dominates health policy debates is out of date. Battistella takes on popular misconceptions about the advantages of single-payer plans, the role of the market, and other health policy issues and outlines a pragmatic new approach.

Few would disagree that the current system is broken. Employer-supplied health insurance no longer works; it imposes a heavy burden on American companies when they compete against international firms and creates insecurity and instability for American workers. But, Battistella asserts provocatively, a government takeover of health insurance patterned after Medicare and Medicaid won't work either. With a battered economy and an aging population, the country simply can't afford it. Battistella argues that contrary to popular belief, single-payer coverage will not lower health spending but would encourage overconsumption and drive costs up. The most efficient and affordable way to reform health care, Battistella contends, is for consumers to take ownership of it. If consumers were responsible for buying their own health insurance (as they are for buying their own car and home insurance), he argues, they'd look for value and demand greater price and quality transparency from providers. Health insurance would be more like other forms of insurance and focus on major expenses, with routine care paid for out of pocket.

The economic shibboleth that the principles of market competition don’t apply to health care is nonsense, Battistella says. We won't achieve real health care reform until policy makers adjust to this reality and adopt a more pragmatic view.


  • Health care is a social good that should be free to all.
  • Single-payer coverage lowers health spending and eliminates social and economic health disparities.
  • Prevention generates big savings.
  • More health spending will stimulate the economy and have a positive effect on health status and longevity.
  • Canada provides a desirable blueprint for U.S. health reform.
  • The principles of market competition aren't applicable to health care.


About the Author

Roger M. Battistella is Emeritus Professor of Health Policy and Management in the Sloan Graduate Program in Health Administration at Cornell University.

Table of Contents

  • Health Care Turning Point
  • Health Care Turning Point
  • Why Single Payer Won’t Work
  • Roger M. Battistella
  • The MIT Press
  • Cambridge, Mass.
  • London, England
  • ©
  • 2010
  • Massachusetts Institute of Technology
  • All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher.
  • For information about special quantity discounts, please email special_sales@mitpress
  • This book was set in Palatino by Graphic Composition, Inc. Printed and bound in the United States of America.
  • Library of Congress ­Cataloging-­in-Publication Data
  • Battistella, Roger M.
  • Health care turning point : why single payer won’t work / Roger M. Battistella.
  •  p. ; cm.
  • Includes bibliographical references and index.
  • ISBN 978-0-262-01407-6 (hardcover : alk. paper)
  • 1. Medical policy—United States. 2. Health care reform—United States. I. Title.
  • [DNLM: 1. Health Care ­Reform—United States. WA 540 AA1 B336h 2010]
  • RA395.A3B285 2010
  • 362.1’0425—dc22
  • 2009033439
  • 10 9 8 7 6 5 4 3 2 1
  • The men of any generation are like dwarfs seated on the shoulders of giants. If we are to see more things than the ancients and things more distant, it is due neither to the sharpness of our sights nor the greatness of our stature but simply because they have lent us their own.
  • —Bernard of Chartres
  • To my mother who sacrificed for a dream—
I hope I have made her proud.
  • Contents
  • Acknowledgments xi
  • Introduction xiii
  • 1 Health Policy: Then and Now 1
  • 2 Resistance to Change 19
  • 3 Contemporary Challenges 37
  • 4 Contemporary Realities 59
  • 5 Popular Misconceptions 77
  • 6 Health Policy Reconfigured 109
  • References 135
  • Index 153


"Roger Battistella has provided a timely, comprehensive and insightful analysis of the complexity of health care policy in the United States. Health Care Turning Point is the most provocative and valuable synthesis of the economic, political, demographic, structural, and cultural aspects of our current health care dilemma. Leaders in every sector of the health care economy will benefit from Dr. Battistella's critical thinking as health care reform takes shape."
Nancy Schlichting, President and Chief Executive Officer, Henry Ford Heath System

"In Health Care Turning Point, Dr. Battistella offers timely and compelling insights that challenge conventional beliefs about what will fix our health care system, and ultimately make it more affordable and user-friendly for all American consumers."
Mark T. Bertolini, President, Aetna

"Roger Battistella explains why it is so difficult to achieve successful reform of our health care system, and why ideology is playing less of a role in today's reform debates. From specialty groups obtaining regulations to thwart new business models, to the steady erosion of traditional employer-based insurance, to the inherent weaknesses of national health insurance, he cogently explains why the realities of today's system are causing policy makers to seek more pragmatic solutions. Battistella's thorough research and keen observations will help specialists and lay readers alike better understand the system's problems and what to do about them."
Stuart M. Butler, Vice President for Domestic Policy, The Heritage Foundation

"Battistella advocates practicality and pragmatism as an alternative to ideological panaceasa timely reminder and important reading as the country struggles through its latest attempts at health care reform."
Gail Wilensky, Project Hope