Health care reform has dominated public discourse over the past several years, and the recent passage of the Affordable Care Act, rather than quell the rhetoric, has sparked even more debate. Donald A. Barr reviews the current structure of the American health care system, describing the historical and political contexts in which it developed and the core policy issues that continue to confront us today. This comprehensive analysis introduces the various organizations and institutions that make the U.S. health care system work -- or fail to work, as the case may be. A principal message of this book is the seeming paradox of the quality of health care in this country -- on one hand it is the best medical care system in the world, on the other it is one of the worst among developed countries because of how it is organized. Barr introduces readers to broad cultural issues surrounding health care policy, such as access, affordability, and quality. He discusses specific elements of U.S. health care, including insurance, especially Medicare and Medicaid, the shift to for-profit managed care, the pharmaceutical industry, issues of long-term care, the plight of the uninsured, medical errors, and nursing shortages. The latest edition of this widely adopted text updates the description and discussion of key sectors of America's health care system in light of the Affordable Care Act. Praise for previous editions "Excellent starting point for exploring the complexities of U.S. healthcare." -- Future Survey "This book stands out for its emphasis on the historical roots of modern health care institutions... Barr's new book has much to recommend it." -- JAMA "A lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face... Even those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking." -- Philosophy, Ethics, and Humanities in Medicine "Barr's book is intended to inform the reader of the complex history of health care in the United States." -- Journal of Health Care for the Poor and Underserved