Document Type

Book Review


Health care reform tops our national policy agenda, ranking second only behind Iraq as the issue that the public wants the 2008 Presidential candidates to address. This is no surprise, as health care spending represents nearly one out of every six dollars spent in the national economy, costs continue to climb, and health insurance is increasingly hard to get, keep, and afford. The numbers are staggering, and numbing. Most of us have heard that 46.5 million people were without insurance for the entire year in 2006, and nearly 89.6 million people were without insurance for some period during 2006 or 2007 -but what does that mean?

In this vivid and moving book, Susan Starr Sered, an anthropologist, and Rushika Femandopulle, a physician specializing in health care policy set out to find some answers to these troubling and very important questions:

Where are the uninsured? Who are they? Why are they uninsured, and how do they scrape by? What does the absence of consistent access to medical care mean in their lives? What is its impact on their jobs, their families, their aspirations? And, equally important, what does the fact that more than forty million Americans lack reasonable access to health care mean for our country as a whole?

Together, they conducted in-depth interviews with 120 uninsured women and men, as well as numerous health care providers, researchers, policy makers, and advocates. Rather than examine "the problem of the uninsured," they let the uninsured speak to us of their problems in their own words. Facts and figures are woven in throughout, providing social, legal, and historical context to the lived experiences of the men and women interviewed.

Written in a readable, engaging style, this book is well-suited to a nonexpert audience and offers something for experts in health law and policy as well. These well-chosen stories can serve as a test suite for evaluating proposals for reform at the dinner table, in the classroom, or as part of public debate. The authors' stated intention is to provoke discussion, and the original interviews were conducted with an eye toward the 2004 Presidential election. This revised edition has been updated with follow-up interviews and a new afterword linking their findings to some recent health care trends, just in time for the 2008 Presidential election.