The 2010 Affordable Care Act is a sweeping reform to the US health care system. Hoffman offers an engaging and in-depth look at America's long tradition of unequal access to health care. She argues that two main features have characterized the US health system: a refusal to adopt a right to care and a particularly American type of rationing. Unlike rationing in most countries, which is intended to keep costs down, rationing in the United States has actually led to increased costs, resulting in the most expensive health care system in the world.

Prologue : rights and rationing before 1930 -- A crisis of access -- Social security without health security -- Health care at war -- Rights to refuse : the triumph of the hospital -- Rationing by coverage : the rise of private health insurance -- Entitlements but not rights : Medicare and Medicaid -- The rise of health care activism -- Emergency rooms and epidemics -- At the breaking point -- Epilogue : rights, rationing, and reform.