U.S. health reform – The cartoon version


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Health Care Reform, by Jonathan GruberIn a landmark decision, the U.S. Supreme Court today upheld the main provisions of President Obama’s Affordable Care Act, including the individual mandate (i.e., everyone must buy health insurance). It represents a major step towards universal coverage for health care in the U.S., something that many countries around the world are striving to achieve.

For those interested in gaining a better understanding of this complex legislation, you can do no better than to start with a graphic novel about the law written by Jonathan Gruber, a professor at MIT and one of the main architects of the Affordable Care Act (and, for that matter, of the Massachusetts health reform that it closely resembles). It’s a great introduction to the policy issues surrounding market failure in health insurance, without having to wade through a dry textbook or World Bank report.

Gruber refers to the individual mandate as part of a “three-legged stool,” along with rules to prevent insurers from denying coverage and subsidies for those who cannot afford insurance, upon which the legislation stands.

In a presentation that I attended earlier this year, Prof. Gruber said that the idea for the book came partly from his teenage son, a graphic novel fan who he was regularly telling to “read a real book,” to which his son replied, “why don’t you write a real book?”

It’s a great reminder that technically-sound, policy-relevant analytical work does not have to be 200 pages of small-font jargon – it can also be made into a fun, interesting read.


World Bank and Health Systems/Financing



Patricio V Marquez
June 29, 2012

Indeed great news!! The US Supreme Court decision to upheld the individual mandate to obtain health insurance, the key provision of the law, facilitates the implementation of the other key provisions by spreading the risk among different population groups, particularly to prevent the refusal of coverage in case of preexisting conditions (our elderly mothers will be happy) and the utilization of community rating to help disassociate medical conditions with higher, unaffordable premiums for people in need of health care. The law will also do wonders to flexibilize the labor market by allowing people to overcome the real fear of being without health insurance coverage in case of termination of employment or during a transion from one job to another.

This law will pass into history as a landmark one similar to President Johnson's Medicare/Medicaid and Civil Rights Acts promulgated in the mid-1960.

A great lesson for all of us on the reality of the political economy of health reform!!! Not everything is technical details.