obamacare

Our Dollar, Your Problem: An Insider’s View of Seven Turbulent Decades of Global Finance, and the Road Ahead

by Kenneth Rogoff  · 27 Feb 2025  · 330pp  · 127,791 words

of 2007 to 101 percent at the end of 2012, and that was on top of a major (albeit much needed) new health-care program, Obamacare. And then during the pandemic, when policymakers embraced the bigger-for-longer deficits theory, debt rose from 107 percent of GDP at the start of

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inequality in, 313 n.5 inflation in, 46, 119, 253 Inflation Reduction Act, 8 laws of, 226 military prowess of, 211, 217–18, 237–41 Obamacare, 281 risk, attitude towards, 223–24, 225, 228 sanctions, weaponization using, 217 Securities and Exchange Commission, 188, 204 Social Security, 319 n.11 stimulus package

America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System

by Steven Brill  · 5 Jan 2015  · 554pp  · 167,247 words

February. They were fed up, they proclaimed, with bailouts, crony capitalism, secret deals, and the government relentlessly trying to interfere with their lives. To them, Obamacare epitomized all that. The next day, in Adel, Iowa, Chuck Grassley got booed off the stage by hecklers holding “You’re fired” signs. Their principal

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had generally kept the doctors’ payments from being reduced, typically freezing them with little or no upticks for inflation. In return for getting support for Obamacare from doctors and their main trade group, the American Medical Association, the Obama administration, Kennedy’s staff, and Baucus’s staff had all promised the

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Obama’s celebration of Ted Kennedy’s “large-heartedness.” “You lie,” Wilson shouted when the president promised that undocumented aliens would not be covered by Obamacare. Obama was telling the truth. No version of the pending draft covered people who were in the country illegally. Nonetheless, Wilson’s outburst hogged much

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corrected in a routine “fix” that would get a unanimous vote. However, with Republicans already talking about repeal, no unanimous vote on anything related to Obamacare was likely. “ASSUMPTION THAT PASSAGE = EXECUTION, WHICH IS WORRISOME” The night of the House vote, Obama gathered his staff on the Truman Balcony for a

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central federal website. A “PENALTY,” NOT A “TAX” The reason their prognosis had changed so much for the worse was simple: The vituperative politics of Obamacare hadn’t subsided following its passage. Quite the opposite. It had intensified. Repeal had become a Republican rallying cry for the 2010 midterm elections. And

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insurance policies would be canceled on December 31. AN EARLY TECH WIN On June 30, 2010, the Department of Health and Human Services launched an Obamacare-related website that suggested that anyone worried about the agency’s digital proficiency was crying wolf. The site, envisioned as a forerunner to the exchanges

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everything we could from Washington. But we kept it as our program.” Even the name was Kentucky-bred. To Kentuckians this would be “Kynect,” not Obamacare. Other governors took the opposite approach. In Minnesota, Republican Tim Pawlenty, preparing for a 2012 presidential race, announced that he would turn down all grants

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she was not certain of its existence. CHAPTER 14 AN OFFICE BECOMES A CENTER—AND IT MATTERS January—June 2011 “ONCE OCIIO BECAME CCIIO, IMPLEMENTING [OBAMACARE] became pretty much impossible.” Huh? That was the explanation that was later offered to me by a senior Obama administration official as troubles with the

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the regular annual appropriation process that the House controlled. This included the money for OCIIO. Worried not only about that, but also about the baggage Obamacare now seemed to present going into the president’s 2012 reelection campaign, the administration went into a full defensive crouch. The bureaucratic upshot was that

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million getting welfare checks in 1997 when President Clinton compromised with the Republicans and reformed the program. Put simply, between the subsidies and Medicaid expansion, Obamacare was a massive income redistribution program providing health insurance to those who could not pay for it—something Democrats in a different time might have

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been proud, rather than afraid, to acknowledge. But heading into the 2012 reelection campaign, it was better to trumpet Obamacare as a modern innovation that would force another hidebound industry to be more competitive. “Expedia for health insurance” was a more winning bumper sticker than

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added was in designing and building user-friendly, efficient technology systems and websites for complicated government programs. The other teams working in the administration on Obamacare were assured by the CMS procurement officials that CGI was the smart choice. The firm had handled other CMS contracts well and had won high

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owned and ran Seton, declined to respond to requests for comment on his hospital’s billing or collections policies. Senator Grassley’s provisions in the Obamacare bill that prohibit tax-exempt hospitals from charging chargemaster rates to patients needing financial aid would have restricted the Daughters of Charity in this situation

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prices. Aware of the leverage that drug companies—especially those with unique lifesaving products—have on the market, most developed countries had, by the time Obamacare was passed, regulated what drugmakers could charge, limiting their profit margins. In fact, the drugmakers’ securities filings routinely warned investors of tighter price controls that

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had become a sophisticated consumer, having learned about those policies with annual limits the hard way. As a result, she had a major complaint about Obamacare. She thought the Obama administration had been too lenient in dealing with inadequate insurance policies. After Lambrew issued her rules allowing policies like Scott’s

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the government’s lawyer, Solicitor General Donald Verrilli, that “you are changing the relationship of the individual to the government.” What was additionally discouraging to Obamacare supporters—including Liz Fowler, who was in the chamber on the second day—was that Solicitor General Verrilli let the hostility knock him off-balance

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focused, would collect $27 million. Filipic was working closely with David Simas, another campaign alumnus who had been assigned to supervise the White House’s Obamacare messaging and marketing, much the way he had worked on the communications effort during the congressional deliberations. But Filipic had another, more important day-to

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unambiguous. On May 9, 2013, three weeks after the Baucus “train wreck” hearing, Beshear used the consultants’ white paper to justify his decision to expand Obamacare to reach every poor person in his state. “The expansion,” he declared at a press conference, “will help hundreds of thousands of Kentucky families, dramatically

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mandate was in place. Better yet, Kushner’s investor deck noted, Oscar expected that 80 percent of its customers would be buying that insurance with Obamacare’s federal subsidies. Oscar would be competing for those customers, the investment presentation said, with “legacy” insurers who had “hard-to-read mailers, poor communication

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the website posting, Treasury was giving up, at least for now. “The Administration is announcing that it will provide an additional year before the ACA [Obamacare] mandatory employer and insurer reporting requirements begin,” the Treasury notice declared. Despite having had three years and three months since the law was signed in

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analyst writing on the Seeking Alpha website recommended insurance company stocks, which he said were undervalued given the likely positive impact of the launch of Obamacare. Indeed, the stocks of the major insurers had all jumped dramatically since President Obama had signed the law in March 2010, outpacing the overall post

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federal Office of Personnel Management should issue a clarification that made sure Grassley’s intention would prevail. But now this had been exploited by the Obamacare opponents. Across the blogosphere and cable news echo chamber there were outraged complaints that Congress and the administration were secretly seeking to exempt Congress and

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his dental department ($1.798 million). PTSD? Polls taken throughout September 2013 showed the cost of all the bad press. CNN reported that support for Obamacare had slipped from 51 percent in January to 39 percent. Fox News reported that “68 percent of Americans are concerned about their personal healthcare” under

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dominate campaigns, issue advocacy, and lobbying in a way that similarly encouraged fighting until the bitter end, rather than compromise. So, the CMS people launching Obamacare were right. Almost anything anyone did or said threatened to spark another firefight in today’s Washington. In September 2013, they didn’t dare look

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off in monthly payments” of $100, extending over the next five years. But what about those provisions that Iowa senator Chuck Grassley had inserted into Obamacare prohibiting exactly that kind of collection suit by purportedly nonprofit hospitals unless and until the hospital made aggressive efforts to determine if the person needed

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the Shelbyville enrollment center that day had been put into the Medicaid program that Beshear had expanded, a plurality that would ultimately mirror all Kentucky Obamacare enrollments. (Eighty percent would qualify for Medicaid.) The fifth family lived about 100 percent above the poverty line of $24,000 for a family

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be better news. Meantime, Obama and his team had a government shutdown and debt ceiling to contend with. Monday, October 7, began with White House Obamacare communications guru David Simas initiating a series of tweets alternating between attacking Republicans for the shutdown and retweeting good news stories about someone having successfully

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enrolled in Obamacare. That same morning Bryan Sivak replied to an email from an executive at Amazon’s Web services division. It had been sent to him because

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, another insurer, WellPoint, told stock analysts during a conference call that it was raising its earnings estimates for the year and that interest in the Obamacare exchanges appeared “robust.” STAND-UPS AND HICCUPS It was above a “Smile Center” dental clinic in a nondescript office building in Columbia, Maryland, in a

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about fifty people enrolled. Meantime, Filipic’s opposite numbers at Generation Opportunity—the group organized and funded by the Koch brothers and other opponents of Obamacare to discourage the young from enrolling—applied their brand of humor to the opportunity Filipic’s former White House colleagues had handed them. They gave

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appeared with Emanuel on a panel at the Council on Foreign Relations in Manhattan to discuss the American healthcare system. When I casually mentioned that Obamacare had neglected tort reform, Emanuel angrily declared that “President Obama has done more for medical tort reform than any president in history.” As he

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stopped pulling $913 a month out of her checking account and refunded it. CHAPTER 23 THE FINISH LINE January 1–April 15, 2014 ALTHOUGH THE OBAMACARE WEBSITE HAD NOW OBVIOUSLY RECOVERED there was still no smoothly functioning electronic link connecting the exchange to the insurance companies so that someone signing up

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been mistakenly denied a mammogram because the outsourced service that vetted radiology procedures had mislabeled her request. OBAMA ON THE ATTACK On January 28, 2014, Obamacare was back in the headlines. The president devoted a portion of his State of the Union address to it, attacking House Republicans for now having

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they never expected.” MORE FRIDAY NIGHT REGULATIONS AND MORE PULLBACKS FROM THE LAW On Friday night, March 14, 2014, CMS issued 335 pages of new Obamacare regulations, documenting a further retreat from the original law. Grandfathering restrictions on insurance plans that did not meet the law’s coverage requirements were loosened

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federal contract qualifying the company to do multiple projects for the General Services Administration. Should we admire Oscar and its founders and be glad that Obamacare gave birth to their different kind of insurance company? Sure. However, the harder question is whether Oscar’s consumer-centric ethos, cool technology, and commonsense

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doing for healthcare what travel websites did for buying airplane tickets. In fact, while travel agents have been largely pushed aside by travel websites, the Obamacare exchanges create more need for insurance agents. Beyond all that, does the Affordable Care Act really provide affordable care? Yes, for millions of Americans. But

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the hospital probably loses “something” on Medicaid patients. Yet, as we can now tell from the rosy earnings reports from publicly held hospital chains since Obamacare launched, even the expansion of Medicaid boosts hospital profits because these patients now have insurance and, therefore, do not become charity cases or debt-collection

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circumstances, the information either wasn’t there or was inaccurate, which, in fact, spurred pending suits against Blue Cross Blue Shield in California soon after Obamacare launched. The result has been competition only on the price of monthly premiums, with consumers often disappointed when they later realized they could not go

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step beyond consolidation? “That seems right,” Cosgrove said. In fact, he added, “We recently applied for an insurance license.” “AETNA IS BLOCKBUSTER” Major laws like Obamacare usually get tinkered with and improved in the years following their initial passage. However, in today’s Washington that is not a likely prospect anytime

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Stuart Altman and David Shactman (Prometheus Books, 2011). Landmark, a book published by The Washington Post’s reporting staff, who exhaustively covered the passage of Obamacare as it happened, also provided important grounding as I began my reporting. I also want to thank Professor Uwe Reinhardt, the renowned Princeton healthcare economist

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problems quickly. QUESTION 7 With regard to #4 in the letter (the political climate), how would you explain the difference in what has happened with Obamacare following its passage compared to the mostly-bipartisan acceptance of Social Security and Medicare once the political fights over passing that legislation were over? (I

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House Energy and Commerce Committee that I reviewed and that committee’s subsequent report: http://​archives.​republicans.​energy​commerce.​house.​gov/​Media/​file/​PDFs/​20120531​Obamacare​Deals.​pdf. 12 Harry Reid immediately turned his attention to making sure that he could keep every Democrat on board. Baucus, however, still wanted a

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workers’ healthcare benefits: Zeke Emanuel and the journal of a White House staff member. Emanuel also describes this debate in a book he wrote about Obamacare: Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System (New York

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and enrollment figures were all checked against state records. CHAPTER 14: AN OFFICE BECOMES A CENTER—AND IT MATTERS 1 “Once OCIIO became CCIIO, implementing [Obamacare] became pretty much impossible”: Everyone involved at the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and the White House

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a reporter for Louisville newspaper LEO Weekly: Can be found at http://​fatlip.​leoweekly.​com/​2014/​05/​23/​mitch-​mcconnell-​says-​kynect-​is-​unconnected-​to-​obamacare-​dodges-​questions-​on-​nsa-​spying-​and-​coal-​making-​us-​sick/. CHAPTER 24: STUCK IN THE JALOPY 1 From 2011 to 2013, the median physicians’

Sickening: How Big Pharma Broke American Health Care and How We Can Repair It

by John Abramson  · 15 Dec 2022  · 362pp  · 97,473 words

Goes American Health Care 6. How Doctors Know 7. Manufacturing Belief 8. Market Failure in Medical Knowledge Part III: Moving Forward 9. The Limits of Obamacare 10. The Key to Meaningful Reform: Fix the Knowledge Problem 11. Reform from the Bottom Up Afterword Acknowledgments Notes Index About the Author Copyright About

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care among eleven wealthy nations, and it is the only country to have declined on this measure since 2010, despite the expanded access provided by Obamacare. And since 2000, Americans’ healthy life expectancy has plummeted from thirty-eighth in the world to sixty-eighth in 2019 (now behind China, Cuba, and

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as a whole is being harmed. The final part of this book begins with a summary of the achievements and limitations of recent reform, particularly Obamacare. Going forward, meaningful reform — expanding health-care access to all Americans, improving Americans’ health, and containing our medical spending — will require standing up to the

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citizens to purchase prescription drug coverage starting in 2006, but the program specifically prohibited the government from negotiating price with the manufacturers. And in 2010, Obamacare legislation specifically prohibited the consideration of cost-effectiveness in coverage decisions for government programs or guideline recommendations. (More on these issues in chapters 8 and

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good value” and “the return on spending has been high.” And in 2010, Jonathan Gruber, professor of economics at MIT and a key architect of Obamacare, posited that, for those with good insurance, American health care was the best in the world. Moreover, he asserted, only 10 percent of spending was

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is particularly noteworthy because it occurred during the second half of the longest period of economic expansion in modern times and after the implementation of Obamacare, which, starting in 2014, extended health-care coverage to almost twenty million previously uninsured Americans. But perhaps longevity is just too crude a measure to

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only the efficacy side of the equation. Then in 2010 came a stunning demonstration of Big Pharma’s political muscle: The final version of the Obamacare legislation mandated continuation of the asymmetry of information by specifically banning consideration of cost-effectiveness studies in government-related coverage decisions or guideline recommendations. (As

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will be discussed in the following chapter, Big Pharma committed $150 million to pay for advertisements supporting passage of Obamacare.) A New England Journal of Medicine article asked: “How can our market-driven health system work efficiently if participants lack information about the relationship between

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national investment in medical care and the social determinants of health. This is addressed in part III. Part III Moving Forward 9 The Limits of Obamacare Politically and emotionally, I would have found it a lot more satisfying to just go after the drug and insurance companies and see if we

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’t been full-bore efforts at reform, including the unsuccessful Clinton health plan put forth in 1993 and, more recently, Obamacare, which is the primary focus of this chapter. The success of Obamacare in extending health-care coverage to many millions of Americans is clear. But in the legislative process that produced

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Obamacare, broader reforms — including government-sponsored cost-effectiveness research and a public option to compete on the exchanges with private insurance plans — met with insurmountable resistance.

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Any future reforms will likely encounter as much, if not more, pushback. OBAMACARE: ACCOMPLISHMENTS AND LIMITATIONS The current era of U.S. health-care reform began in 2010 with the passage of the Patient Protection and Affordable Care

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Act, aka Obamacare. The final product of the legislative battles provides important lessons about the limits of reform, even in the context of Democratic control of both houses

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Romneycare (health-care reform implemented in Massachusetts in 2006 that relied heavily on recommendations from the conservative Heritage Foundation and served as the template for Obamacare), the health-care industries will support expansion of coverage “because that creates more customers.” Notwithstanding this advice, once in office, President Obama struggled to achieve

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institute was specifically prohibited from performing cost-effectiveness studies that would “establish what type”* of health care is cost effective or recommended. In other words, Obamacare was forbidden to make exactly the kind of comparative analyses that were necessary for the market to create efficiency. The second cost-saving reform sacrificed

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influx of non-cost-controlled retail customers, it pledged $150 million to pay for advertisements in support of Obamacare. AHIP, the lobbying arm of American Health Insurance Plans, supported the plan because, without Obamacare, states’ movement toward mandatory coverage of preexisting conditions was pushing the cost of non-group insurance so high

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that this niche of their market was at risk of collapsing. In the four years following the passage of Obamacare, the value of the stock of large health insurers doubled, going up twice as much as the Dow Jones Industrial Average. When the dust finally

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settled, the reforms included in Obamacare remained safely within the realm of win-win in the sense that more uninsured Americans would gain coverage and more money would be made by

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the drug, insurance, and hospital companies. And this would hold as long as taxpayers were willing to foot the bill for those subsidies. By 2016, Obamacare had decreased the number of uninsured Americans by 40 percent, to a low of 26.7 million — an improvement, for sure, yet still a far

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the quality and relevance of the scientific evidence available to doctors and other health-care professionals. IGNORING THE WILL OF THE PEOPLE The failure of Obamacare to address many popularly held views about health-care reform was not an anomaly. In a now-classic 2014 paper, Professors Martin Gilens and Benjamin

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, reflecting the strong influence of Big Pharma and other “economic elites,” has not meaningfully addressed any of these publicly supported positions since the passage of Obamacare. Instead, Pharma once again demonstrated its influence by gaining overwhelming legislative support for the 21st Century Cures Act in 2016. The bill, actively supported by

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for the drug companies). And second, more than half of the funding for the bill, $3.5 billion, was taken away from money in the Obamacare Prevention and Public Health Fund that had been earmarked specifically for underfunded population-health interventions, like vaccination and smoking-cessation programs, as well as for

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, more than two-thirds of senators and representatives — split almost evenly between Democrats (47 percent) and Republicans (53 percent) — accepted money from the pharmaceutical industry. Obamacare reduced the percentage of uninsured U.S. adults from 20 percent in 2010 to 12 percent in 2018. But expanding coverage required giving up other

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paradoxically, as the percentage of uninsured Americans declined, U.S. longevity not only failed to improve but actually decreased. Even without these industry-threatening measures, Obamacare never enjoyed bipartisan support, and the Republicans continued their attempts to repeal it or have it struck down by the courts. Going forward, reform will

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continue, at least initially, in the same direction as Obamacare, with the goal of further reducing the number of uninsured Americans. The proposed expansion of coverage will be achieved by increasing federal subsidies to make

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insurance affordable for more lower- and middle-income Americans. But, as President Obama made clear early in the legislative negotiations that culminated in Obamacare, the goals of reform will not be met without both expanding coverage and containing costs. And this cannot be done without proceeding into the territory

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missing part is the role of government in ensuring that those profits do not come at the expense of society. — BINYAMIN APPELBAUM, New York Times Obamacare extended health-care coverage to 40 percent of previously uninsured Americans and the profits of the drugmakers, insurance companies, and hospitals increased, but, as discussed

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uninsured Americans by (1) offering coverage to people who qualify for Medicaid but live in states that rejected federal funds to broaden Medicaid eligibility after Obamacare was implemented and (2) increasing federal subsidies to individuals and families so they don’t have to pay more than 8.5 percent of their

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a powerful dose of reality. Vermont’s state legislature had passed the plan in 2011 with strong support from progressive health-care advocates, who saw Obamacare’s abandonment of the public option as unnecessary capitulation to the private insurance industry. Disappointingly, as implementation progressed, projections showed total health-care spending would

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lesson: Building a firm and realistically informed constituency for reform must be done before trying to legislate changes. As American health care currently stands, the Obamacare approach of expanding coverage and appeasing the vested interests cannot be extrapolated to universal coverage because, as President Obama made clear in 2009, the cost

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benefit) and the public (receiving a far less-than-commensurate health benefit). The result has been entirely predictable. Despite the expanded health-care coverage of Obamacare, our citizens’ longevity has continued to lose ground in comparison to longevity in other wealthy countries, and pre-pandemic Americans’ life spans actually declined in

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, https://www.healthsystemtracker.org/chart-collection/mortality-rates-u-s-compare-countries/#item-leading-causes-death-mortality-rates-higher-u-s-comparable-countries. provided by Obamacare: Sawyer and McDermott, “How Do Mortality Rates.” of just 10.7 percent: Rabah Kamal et al., “Health Spending and the Economy,” Health System Tracker, https

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/why-warren-buffetts-health-care-project-haven-failed-111839197.html. “From biotechnology”: https://www.jpmorgan.com/commercial-banking/industries/life-sciences. 9. THE LIMITS OF OBAMACARE “Politically and emotionally”: Barack Obama, “A President Looks Back on His Toughest Fight,” New Yorker, October 26, 2020. “market society”: Michael J. Sandel, “What Isn

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Looks Back.” risk of collapsing: Brill, America’s Bitter Pill. Dow Jones Industrial Average: “Health Care Stocks: Performance Under Obamacare,” healthcarereform.procon.org, https://healthcarereform.procon.org/health-care-stocks-performance-under-obamacare/. a low of 26.7 million: Jennifer Tolbert, Kendal Orgera, and Anthony Damico, “Key Facts About the Uninsured Population

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-consumer (DTC) advertising, 152 negative stomach acid action, 152–53 omeprazole and, 150 published studies, 151 Novo Nordisk, 61, 70 Obama, Barack, 195–97, 201 Obamacare, 4, 86, 194 cost effectiveness studies in, 170 expansion of coverage, 195, 201 Medicaid expansion, 197–98 Patient-Centered Outcomes Research Institute (PCORI), 197 pharmaceutical

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industry response, 198 public insurance option, 195–97 Romneycare, 195 White House meeting, 196 Obamacare Prevention and Public Health Fund, 200 off-label prescriptions definition of, 20 legality, 36 marketing of, 21 Operation Warp Speed, xiv, xvi–xvii Organisation for

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Cochrane Collaboration; evidence-based medicine Partnership for America’s Health Care Future, 204 patents, pharmaceuticals, 95, 154 Patient Protection and Affordable Care Act (2010). See Obamacare pension fund managers, 188 Pfizer Bextra guilty plea, xxiv–xxv mRNA vaccine, xv–xvii, xix–xx Neurontin Publication Subcommittee, 34 Neurontin trial jury award, 37

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administrative complexity (especially billing), failures in care delivery (especially failure to provide preventive care), overtreatment (especially at the end of life), and fraud and abuse. * Obamacare initially included a public insurance option to compete with private health insurance coverage in the hope of driving down both premiums and underlying health-care

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but at least equally effective recombinant human insulin instead of the newer insulin analogs. † The federal government initially covered 100 percent of the cost of Obamacare’s Medicaid expansion, meaning there was no cost to the states; that amount declined gradually to 90 percent by 2020. * Of course, expanding coverage is

Crashed: How a Decade of Financial Crises Changed the World

by Adam Tooze  · 31 Jul 2018  · 1,066pp  · 273,703 words

-funded group. As far as deficit reduction was concerned, they would accept only spending cuts. And the spending they wanted to stop, in particular, was Obamacare, which they regarded as a lethal “socialist” threat to America’s future. The Republican leadership might worry about losing centrist votes. They knew that the

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the Republican Party into a vehicle for an attack on the creditworthiness of US government, what was safe? So far the Tea Party had made Obamacare its main target. What would be next? By 2014 the Republican Right would block immigration reform and refuse to fund the Export-Import Bank, both

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the Americans were embarrassed to report that funding for the IMF was being held hostage by Republican opponents of abortion who wanted contraception excluded from Obamacare.63 What if the Republican zealots targeted Fed independence or trade policy next? Of course, there were business interests aligned with the Tea Party on

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that happened it would be good for the banks, at least in the short run. Health-care stocks surged as markets anticipated a rollback of Obamacare and its cost cutting. There was also a bump in infrastructure stocks. Meanwhile, bonds sold off as the prospect of Trumpflation made it all the

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than ever. Since 2009 the congressional Republicans had been waging relentless political war, first against the stimulus, then the Affordable Care Act, also known as Obamacare. Twice in 2011 and 2013 they had taken the debt ceiling hostage. Now, with control of both the presidency and Congress, what would they do

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? Obamacare was the scalp they wanted most and it ought to have been easy. As it had emerged from its congressional ordeal in March 2010, the

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hundreds of billions of dollars began to flow through its channels. Indeed, among the states that benefited most from the extension of health coverage under Obamacare were Kentucky and West Virginia, diehard Trump country.55 As Trump took office, support for the ACA among the most important group of voters, Independents

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from 36 percent in 2010 to 53 percent.56 By the summer, when the desperate Republican congressional leadership made a last bid simply to repeal Obamacare without replacement, they had the support of only 13 percent of Americans.57 Not surprisingly, sufficient Republican moderates refused to go along. If they couldn

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’t repeal and replace Obamacare, what could they do? By the summer of 2017 it seemed that the incoherence of the Republicans, when faced with the complex reality of modern

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having saved the administration from a shutdown, Trump was only too happy to cheer on the Republicans as they returned to the attack.65 Scrapping Obamacare might not sell as a political proposition, but cutting taxes surely would. The Republicans in the House and Senate began urgent work on “tax reform

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is a ‘B minus.’”80 The markets weren’t cheering but neither did the Trump administration have vigilantes on its tail. The congressional infighting over Obamacare and the Republican tax cuts was bare-knuckle American politics. But a clue to the relative calm in the Treasury market could be found in

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cumulative change since 2010) Source: IMF, Global Financial Stability Report, Ocober 2017, 19, figure 1.13, panel 4. IV The Republican campaigns to roll back Obamacare and cut taxes were of long standing. Trump’s targeting of Wall Street in his election campaign was more novel. But it made electoral sense

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repeal, the CHOICE Act had little or no chance of passing the blocking position the Democrats held in the Senate. As in the battle against Obamacare, the struggle was best waged outside the spotlight. Even if Dodd-Frank remained in place, the regulatory regime was fair game. This was a legacy

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View, June 30, 2008, http://economistsview.typepad.com/economistsview/2008/06/brad-delong-the.html. 55. “Kentucky Residents Express Dissatisfaction with GOP Efforts to Dismantle Obamacare,” All Things Considered, NPR, July 18, 2017, https://www.npr.org/2017/07/18/537948591/kentucky-residents-express-dissatisfaction-with-gop-efforts-to-dismantle-obamaca

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. 56. H. Fingerhut, “Support for 2010 Health Care Law Reaches New High,” Pew Research Center, February 23, 2017. 57. R. Savransky, “Poll: Support for ObamaCare Repeal-Only Plan at 13 Percent,” The Hill, July 19, 2017. 58. R. Berman, “The Republican Majority in Congress Is an Illusion,” Atlantic, March 31

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-owner relief, failure to provide, 281, 321 partisan hostility to, 278 Russian “reset” and, 488 stimulus package, passage of, 277–79, 280–82, 289–90 Obamacare. See Affordable Care Act Occupy Wall Street, 394–95, 459 oil and commodity price collapse of 2008, 222–23 of 2014, 503–4, 601 OMT

The Rise and Fall of American Growth: The U.S. Standard of Living Since the Civil War (The Princeton Economic History of the Western World)

by Robert J. Gordon  · 12 Jan 2016  · 1,104pp  · 302,176 words

world while providing only partial coverage. On the eve of the passage of the Patient Protection and Affordable Care Act of 2010, better known as Obamacare, 16 percent of U.S. citizens lacked health coverage, higher than the 12 percent who had lacked insurance in 1987.124 The burden of lack

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cover a pre-existing condition but who were denied coverage because of that very condition. It is too early to determine the overall effect of Obamacare on the share of health care spending in GDP or the efficacy of medical care. The program has three beneficial features. First, it deals directly

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annual premium cost to $828 per year, or only $69 per month. In fact, 85 percent of those who signed up for health coverage under Obamacare in 2015 were eligible for subsidies. Second, despite the high deductibles, an extensive set of preventive screening tests is offered free of any copays, including

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preventive screening would be paid for by the patient up to the limit of the deductible.126 The problems with Obamacare begin with its complexity. An inquiry in February 2015 to the Obamacare website healthcare.gov for my state of Illinois lists 142 different plans, each offering a different menu of premiums

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ever-changing lists of drugs that are covered, that require high copays, or that are not covered at all.127 The complexity and restrictions of Obamacare contrast notably with the simplicity of Medicare and its single-payer system, from which most doctors and hospitals accept payments. In its effort to obtain

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option, apparently fearing an onslaught of opposition from lobbyists for the private insurance industry. Although it is much too soon to gauge the effects of Obamacare on health wellness indicators such as life expectancy, it is encouraging that, as shown in figure 14–7, the long-term increase in the share

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of medical care spending in GDP appears to have stopped, at least temporarily, during 2010–13, even before Obamacare enrollments began in 2014. CONCLUSION The U.S. health care system changed dramatically after 1940 in its methods of treating illness, in its organization of

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system, although the distinction between in-network and out-of-network providers made managed care quite unpopular. The problem of limited networks was exacerbated by Obamacare, which suffered from the complexity of hundreds of different plans, each offering narrow provider networks that were plagued with relatively high provider turnover. At least

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Obamacare helped to bridge the coverage gap with medical insurance that was subsidized along a sliding scale depending on income, that was available without denial for

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(2006), p. 64. 124. Winship (2012), p. 17. 125. Yount (2001), p. 25. 126. Facts about subsidies from obamacarefacts.com/costof-obamacare and about preventive screening from obamacarefacts.com/Obamacare-preventive-care/. 127. Details in this paragraph and the quotation are from Rosenthal (2015), p. 7. 128. Bud (2007), p. 3. 129

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; debt of, 607, 629–30, 638; economic growth promoted by, 310–16; Interstate Highway System built by, 389–93; Medicare and Medicaid programs of, 489; Obamacare program of, 493–95; regulation by, 649; World War II manufacturing financed by, 564 Federal Housing Authority, 369 Feldstein, Martin, 650 females. See women feminist

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price of light, 119; on value of health and life expectancy, 242–44, 323 nursing schools, 230 nutrition. See diet; food Obama, Barack, 628–29 Obamacare (Patient Protection and Affordable Care Act; 2010), 493–95, 496–97 obesity, 345–47, 371, 469 O’Brien, Jeffrey, 479 occupations: from 1870 to 2009

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tires, 150; on software and business methods, 649; for telegraph, 177; for telephone, 181, 183, 204; for television, 413 Patient Protection and Affordable Care Act (Obamacare; 2010), 493–95, 496–97 Patients’ Bill of Rights, 477 paved roads, 157–59 pawnbrokers, 292, 296 peddlers, 78, 88, 295 penicillin, 224, 324, 465

Kill Switch: The Rise of the Modern Senate and the Crippling of American Democracy

by Adam Jentleson  · 12 Jan 2021  · 400pp  · 108,843 words

off their plans and forced to shop for health care on their own, minus the contributions, they would be the beneficiaries of an “exemption” under Obamacare. It was an absurd theory, and it would amount to a financial hit of thousands of dollars for the average person.2 Privately, Republicans agreed

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let it get out there that this is for the Spkr and Ldr to ask the President to carve us out of the requirements of Obamacare.” Krone replied, suggesting that the White House tell reporters that the meeting was about immigration. Sommers wrote back, “I really don’t care what it

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Senate to the superminority’s will. By the fall of 2013, the fight over his amendment had become part of a larger push to defund Obamacare. The fight was led by Senator Ted Cruz of Texas. Congress controls the power of the purse, so all the funding needed to implement

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Obamacare passed through the Senate. Cruz urged Republicans to block all funding bills related to Obamacare. There was one problem with his strategy: it had no chance of success. Congressional Democrats were not going

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Burr were calling on them to do the responsible thing, and the leaders knew full well that Vitter’s amendment, Cruz’s push to defund Obamacare, and the ante-upping drive to shut down the government were all pathologically irresponsible. But on the other hand, they were scared to publicly oppose

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looking over their shoulders, terrified of becoming the Tea Party’s next target. In 2013, this constellation of forces took up the fight to defund Obamacare and shut down the government. Heritage provided Cruz with a platform to make his case. At a Heritage-sponsored speech in August, Cruz delivered a

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firm and gave Republicans nothing. Under pressure from an outraged public, Republicans caved, allowing the government to reopen with nothing to show for their effort. Obamacare remained untouched. “Goose egg, nothing, we got nothing,” said GOP representative Thomas H. Massie. The Tea Party’s strategy had been a disaster, it seemed

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interviewer pointed out that several Republicans were negotiating with Democrats, but Kyl rejected any prospect of Republican support on the final product, flatly stating that Obamacare “will not be a bipartisan product.”42 The arm-twisting became an open secret; in July, the Los Angeles Times reported that Grassley was “under

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member post if not for the healthcare debate,” the story concluded.52 After the story ran, Snowe told McConnell she’d changed her mind about Obamacare. When the bill came to the floor, Snowe assured him, she would vote against it. She later explained that McConnell “doesn’t twist arms so

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in securing a bare majority for major legislation was on full display in their quixotic quest to repeal the Affordable Care Act, otherwise known as Obamacare. Despite campaigning on repeal for seven years, Republicans struggled to follow through once they controlled both chambers of Congress and the White House.117 In

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. 34.Alberta, American Carnage. 43. 35.Acosta, Jim. “Romney Once Touted Parts of ‘Romneycare’ as a National Model.” CNN. March 7, 2011. 36.Lane, Thomas. “Obamacare & Romneycare Are ‘the Same Fucking Bill’ Says Former Romney Adviser.” Talking Points Memo. November 16, 2011. 37.Butler, Stuart. “Assuring Affordable Health Care for All

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Americans.” Heritage Foundation. 6. 38.Ornstein, Norm. “The Real Story of Obamacare’s Birth.” Atlantic. July 6, 2015. 39.Brill, Steven. America’s Bitter Pill. New York: Random House, 2015. 93. 40.Alberta, American Carnage. 69. 41

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; and Mascaro, Lisa. “GOP Ready to Make ‘Pledge to America.’ ” Los Angeles Times. September 23, 2010. 118.Werner, Erica; and Fram, Alan. “No Repeal for ‘Obamacare’ in Humiliating Defeat for Trump.” Associated Press. March 24, 2017. 119.Rovner, Julie. “Timeline: Despite GOP’s Failure to Repeal

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Obamacare, the ACA Has Changed.” Kaiser Health News. April 5, 2018. 120.Scott, Dylan; and Kliff, Sarah. “Why Obamacare Repeal Failed.” Vox. July 31, 2017. 121.Pear, Robert; and Kaplan, Thomas. “Senate Rejects Slimmed-Down

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Obamacare Repeal as McCain Votes No.” New York Times. July 27, 2017. A1. 122.Cummings, William. “Senate Republicans Resist

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, Mark. “Romney, Defying the Party He Once Personified, Votes to Convict Trump.” New York Times. February 5, 2020. 130.Guskin, Emily; and Clement, Scott. “Republicans’ Obamacare Repeal Was Never Really That Popular.” Washington Post. July 28, 2017; Easley, Cameron. “Poll: Voters Aren’t Happy with GOP Oversight of Trump Administration.” Morning

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, 130 bills blocked by Democratic filibusters, 244 Jesse Helms and, 149 Republican Party and, 149–50 Abramowitz, Alan I., 131 ACA (Affordable Care Act), see Obamacare ADA (Americans for Democratic Action), 80 Adams, John Quincy, 32–33, 48, 49 Ad Age, 190 advice and consent, 199–200 Affordable Care Act (ACA

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), see Obamacare African Americans and election of 1960, 105 and New Deal programs, 72 and realignment of Republican Party, 131 and Republican Party, 95–96 and shifting

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for Scalia’s replacement, 226 election of 2010, 138 election of 2016, 225 election of 2018, 297 as obstructionist, 126 and Republican push to defund Obamacare, 136 and Tea Party tensions with McConnell in Senate, 224 and 2013 government shutdown, 152 C-SPAN2, 7–8 culture wars, Jesse Helms and, 150

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), 134–39, 150–53 GQ magazine, 221 Graham, Franklin Porter, 140 Grassley, Chuck and Brett Kavanaugh nomination, 231–32 and nuclear option, 199, 223 and Obamacare fight, 214–16 and Senate Judiciary Committee, 230 Grayson, Trey, 138, 220–22 Great Alignment, The (Abramowitz), 131 Great Britain, 33, 35 Great Compromise imbalance

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, 199 Hasen, Richard, 220 Hatch, Orrin, 199–200, 223, 228 Hawaii, 127 Hawley, Josh, 126 Hayden, Carl, 82 Hayne, Robert, 36 health care reform, see Obamacare Heck, Joe, 156 Heitkamp, Heidi, 176 Heller, Dean, 156 Heller, Joseph, 64 Hell’s Canyon dam, 101–2 Helms, Jesse, 139–53 arrival in Senate

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finance reform, 218; see also McCain-Feingold Act death of, 234 election of 2000, 194 Charles Keating and, 193 and McConnell v. FEC, 197–98 Obamacare repeal vote, 234 on Harry Reid’s control of amendment votes, 176 Trump’s comments on, 181 McCain-Feingold Act (Bipartisan Campaign Reform Act), 193

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–7 need to undo damage caused by, 254 and nuclear option, 120, 198–201, 223 number of filibusters employed by, 208 and Obamacare obstruction, 214–15, 217–18 and Obamacare repeal attempts, 234 on obstructing Obama, 5 Rand Paul and, 221 persuasion methods, 217 on potential Democratic win in 2016, 229–30

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Court appointment battles, 10, 182–84, 226–30 2004 Democratic National Convention speech, 208 and 2013 government shutdown, 134, 152 and Vitter amendment, 134–35 Obamacare McConnell’s obstruction, 212–17 public option, 245 Republican push to defund, 136 Tea Party opposition to, 138 Trump-era attempts to repeal, 233–34

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, Marjory Stoneman Douglas High School shooting, 20 Parliament, 56–57, 247 Parra, José, 155 party-unity score, 121 Patient Protection and Affordable Care Acts, see Obamacare patronage, 50 Patton (movie), 205 Paul, Rand, 138, 221 Pearson, Drew, 96 Pelosi, Nancy, 152, 204 Pence, Mike, 205, 234 Percy, Charles, 146 “petticoat affair

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battle, 184, 228–30 Jesse Helms and, 146–47 and Martin Luther King Jr. Day bill, 151–52 and McCain-Feingold bill, 194–96 and Obamacare bill, 213–17 obstruction of Obama as rational, 120–21 and polarization, 121–22 as predominantly white, 129 and red state/blue state divide, 19

Tailspin: The People and Forces Behind America's Fifty-Year Fall--And Those Fighting to Reverse It

by Steven Brill  · 28 May 2018  · 519pp  · 155,332 words

rules were also counted. The spending was actually higher, $3.5 billion, in 2009 and 2010 when consequential legislation, such as the Affordable Care Act (Obamacare) and the Dodd-Frank financial reform bill, was being debated. All of that lobbying was more directly protected by the First Amendment than Martin Redish

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just by Republicans, but by some leading Democrats, including Montana senator Max Baucus. Baucus would later become the Senate Finance Committee chairman who helped write Obamacare—which, in return for the drug industry’s support (including using its PAC money to run ads supporting the law), also did not include a

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the White House, none of his or the congressional Republicans’ proposals to relieve Americans from high health insurance premiums that Republicans charged were caused by Obamacare included anything related to controlling what is actually the most obvious factor in rising insurance premiums: skyrocketing drug prices. In the first six months of

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the Republicans took over the House and then the Senate. During the two years of the Obama administration when Democrats controlled Congress, Obama did get Obamacare passed, but only after having to eliminate plans, at the behest of some of the Democrats whose votes he needed, to include a liberal “public

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refuse to yield any ground to the other, the result is a dysfunctional government. The Republicans’ unanimous, virulent opposition to the Affordable Care Act, or Obamacare, from the day President Obama took office offers a vivid example. The proposal Obama and Democrats in Congress put together in 2009 was not something

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protection against those costs through insurance or some other mechanism (such as government-provided health care). Just as Romney had done, and Nixon had proposed, Obamacare attempted little to deal with the first problem. As explained earlier, to the dismay of many Democrats in the House and Senate, there would be

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payer that would insure all Americans and use its buying power to negotiate lower prices. Although Democrats enjoyed majorities in the House and Senate when Obamacare was being drafted, the health care lobby, by far the most well funded in Washington, had leaned on enough Democrats on Capitol Hill to make

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same mandate. Nonetheless, although their usual allies in the pharmaceutical and most other medical industry sectors either supported or did not oppose it, Republicans attacked Obamacare when it was proposed and just as relentlessly in the years after it was passed with only Democratic votes (except for one Republican House member

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the form of the pungent turns of phrase that had become a Luntz specialty since he had coined “death tax” to demonize the inheritance tax. Obamacare’s “government takeover of health care” would “put some bureaucrat between you and your doctor,” Republicans said. These messages, along with completely fictional claims that

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the Tea Party groups that sprang up in the spring and summer of 2009 and made blocking Obamacare their battle cry. At no time did the Republicans offer an alternative to Obamacare, no doubt because Obamacare had always been their alternative—which foretold the embarrassment they would suffer seven years later when they

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support—Eisenhower’s interstate highway system, Kennedy’s nuclear test ban treaty, Johnson’s civil rights laws and Medicare and Medicaid. The bipartisan breakdown over Obamacare was anything but an outlier. Checks and balances had been weaponized. In the midst of the financial crisis, the Republicans had refused to back Obama

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of the original fight to pass it and the prospect of repeal when the other party took over. That, of course, is what happened to Obamacare, which became law with only one Republican vote. Because it continued to be so bitterly attacked by Republicans, even the traditionally routine process of cleaning

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substantive but incremental steps to improve the law, as both parties had repeatedly done in prior decades to fix major legislation. In fact, long after Obamacare became the law of the land, Republican House Speaker John Boehner often continued referring to it as a “bill,” as if it was still being

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. Ignoring their own party leaders, they refused to agree on a deal to extend the budget even temporarily unless President Obama eliminated all funding for Obamacare. It was an obviously ridiculous demand, but they held out for nearly two weeks before popular disgust forced party leaders to break the Hastert Rule

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and former Republican Senate majority leader (and physician) Bill Frist, working with Democratic and Republican staff experts, had produced a sensible set of fixes for Obamacare. BPC had an infrastructure plan ready to go, as well as proposals for reforming the federal budgeting process, for streamlining government regulations, and for fixes

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that overwhelming majorities of Americans favor. As we have seen, the version of health care “reform” that could make it out of Congress in 2010, Obamacare, was a law that produced government-subsidized profit increases for all the players in the industry. The health care lobby, by far the most heavily

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premiums for employer-provided health insurance) grew 460 percent. The percentage of workers who were no longer offered insurance (at least until the passage of Obamacare) either because employers decided they could not afford it or because they shifted to outsourced, contract workers to avoid the cost, also increased. That cut

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governors, not a Washington mandate. As the Tea Party sprang up, however, the union was able to convince these ultra-anti-Washington conservatives that, like Obamacare, Common Core—which, again, was created and implemented by the National Governors Association—was another Washington assault on freedom. Except for Florida’s Jeb Bush

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the website that the Obama administration built to launch the consumer health care insurance exchanges that were central to Obamacare. By the end of the first hour of the launch of the Obamacare e-commerce site on October 1, 2013, the system was down, and no one knew why. Because it had

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discarded, original e-commerce site had taken more than two years to build. Obama told me he had “learned a lot of lessons” from the Obamacare crash, “and we’ve taken steps to apply those lessons across the government.” The primary lesson involved a fresh look by the administration, from the

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make them un-poor. These are the people who depend on food stamps, rental assistance, unemployment insurance, and Medicaid, or the premium subsidies on the Obamacare health insurance exchanges. A political leader with the right skills should be able to rally them—the poor and those hovering near the poverty line

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worse.” Obama undercut his efforts to break the fever with poor messaging and, sometimes, poor management, such as the debacle that accompanied the launch of Obamacare. He failed to accompany the programs funded by his stimulus program, such as infrastructure upgrades, with the kind of marketing that would have conveyed to

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his initiative that was funding the improvements and the jobs created by them. He failed to drive home to poor and middle-class families how Obamacare was meant for them, something they only realized when the Republicans tried to take it away seven years later. There was little effort to showcase

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? The Electoral Consequences of Rising Trade Exposure,” NBER Working Paper No. 22637, September 2016, http://www.nber.org/​papers/​w22637. 7 DYSFUNCTIONAL DEMOCRACY Obamacare: I wrote a book about Obamacare, Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, published by Random House in 2015. Except

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this statement, for example, he moves from calling it a law to a bill and back again: http://abcnews.go.com/​Politics/​video/​john-boehner-obamacare-wreaks-havoc-american-families-21085758. immigration reform law: The Border Security, Economic Opportunity, and Immigration Modernization Act (S.744) passed in the Senate with a

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/​cgi/​viewcontent.cgi?article=1011&context=caselrev. shut down the government: In late September, Senator Cruz filibustered for over twenty-one hours in opposition to Obamacare: https://www.c-span.org/​video/​?c4466033/​sen-ted-cruz-complete-remarks. Gridlock over the health care bill caused a shutdown that began on October

Arguing With Zombies: Economics, Politics, and the Fight for a Better Future

by Paul Krugman  · 28 Jan 2020  · 446pp  · 117,660 words

: After the Khaki Election Social Security Scares Inventing a Crisis Buying into Failure Social Security Lessons Privatization Memories Where Government Excels 2. THE ROAD TO OBAMACARE Essay: Developing a Positive Agenda Ailing Health Care Health Care Confidential Health Care Terror The Waiting Game Health Care Hopes Fear Strikes Out

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Obamacare Fails to Fail Imaginary Health Care Horrors 3. THE ATTACK ON OBAMACARE Essay: The Cruelty Caucus Three Legs Good, No Legs Bad Obamacare’s Very Stable Genius Get Sick, Go Bankrupt, and Die How Democrats Can Deliver

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rise to $708 billion and Medicaid spending to $361 billion. The actual numbers for 2014 were 600 and 301, respectively, despite the Medicaid expansion under Obamacare. At least some of this unexpectedly low cost can be attributed to measures included in the Affordable Care Act. And strange to say, this was

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what doesn’t. Privatized retirement schemes work very badly; Social Security works very well. And we should build on that success. 2 The Road to Obamacare DEVELOPING A POSITIVE AGENDA I’M NOT A REAL HEALTH CARE ECONOMIST, BUT I PLAY ONE ON TV—AND, more important, on the Times op

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(kind of like the Bush Social Security push). Was there any chance of a successful do-over? Yes, there was. The Affordable Care Act, aka Obamacare, was an incomplete and imperfect reform, but it nonetheless extended essential health care to tens of millions of Americans. But getting there was anything but

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looked far closer to political feasibility than Medicare for All. Hence the Affordable Care Act, aka Obamacare. The columns in this section document how the argument evolved, how the plan went, and what happened when Obamacare went into effect. AILING HEALTH CARE April 11, 2005 Those of us who accuse the administration

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after the column went to press that Mr. Gingrich said it referred to Johnson’s Great Society policies, not to the 1964 Civil Rights Act. OBAMACARE FAILS TO FAIL July 13, 2014 How many Americans know how health reform is going? For that matter, how many people in the news media

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make a compelling headline, and the people who falsely predicted doom just keep coming back with dire new warnings. Consider, in particular, the impact of Obamacare on the number of Americans without health insurance. The initial debacle of the federal Web site produced much glee on the right and many negative

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those receiving federal subsidies—the great majority of those signing up—the average net premium was only $82 a month. Yes, there are losers from Obamacare. If you’re young, healthy, and affluent enough that you don’t qualify for a subsidy (and don’t get insurance from your employer), your

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. You might ask why, if health reform is going so well, it continues to poll badly. It’s crucial, I’d argue, to realize that Obamacare, by design, by and large doesn’t affect Americans who already have good insurance. As a result, many people’s views are shaped by the

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politics, but Representative Pete Sessions of Texas, the chairman of the House Rules Committee, recently set a new standard when he declared the cost of Obamacare “unconscionable.” If you do “simple multiplication,” he insisted, you find that the coverage expansion is costing $5 million per recipient. But his calculation was a

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about an issue if he won’t bother to read budget office reports. But that is, of course, how it’s been all along with Obamacare. Before the law went into effect, opponents predicted disaster on all levels. What has happened instead is that the law is working pretty well. So

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, in fact, happened. Costs aren’t the only area where enemies of reform prefer to talk about imaginary disasters rather than real success stories. Remember, Obamacare was also supposed to be a huge job-killer. In 2011, the House even passed a bill called the Repealing the Job-Killing Health Care

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Law Act. Health reform, opponents declared, would cripple the economy and in particular cause businesses to force their employees into part-time work. Well, Obamacare went into effect fully at the beginning of 2014—and private-sector job growth actually accelerated, to a pace we haven’t seen since the

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who want full-time work but can’t get it—has dropped sharply. But the usual suspects talk as if their dire predictions came true. Obamacare, Jeb Bush declared a few weeks ago, is “the greatest job suppressor in the so-called recovery.” Finally, there’s the never-ending hunt for

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snarks and boojums—for ordinary, hard-working Americans who have suffered hardship thanks to health reform. As we’ve just seen, Obamacare opponents by and large don’t do math (and they’re sorry when they try). But all they really need are a few sob stories

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’t been able to find those stories. Early last year, Americans for Prosperity, a Koch brothers–backed group, ran a series of ads featuring alleged Obamacare victims—but not one of those tales of woe stood up to scrutiny. More recently, Representative Cathy McMorris Rodgers of Washington State took to Facebook

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to ask for Obamacare horror stories. What she got instead was a torrent of testimonials from people whose lives have been improved, and in some cases saved, by health

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news about costs hasn’t made it through at all: according to a recent poll by Vox.com, only 5 percent of Americans know that Obamacare is costing less than predicted, while 42 percent think the government is spending more than expected. And the favorable experiences of the roughly 16 million

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argument is ever dropped, no matter how overwhelming the evidence that it’s wrong. And the result is that imaginary disasters can overshadow real successes. Obamacare isn’t perfect, but it has dramatically improved the lives of millions. Someone should tell the voters. 3 The Attack on

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CRUELTY CAUCUS WHERE WERE YOU IN JUNE 2012, WHEN THE SUPREME COURT HANDED down its crucial decision on the constitutionality of Obamacare? If you have no idea, you’re not a health policy nerd. I, on the other hand, am. I was on vacation in England, sitting

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it wouldn’t cost them anything. At first you could possibly have rationalized refusal to expand Medicaid as a strategic move, an attempt to discredit Obamacare as a whole. But the A.C.A. has been in effect for a long time now; if refusing to expand Medicaid was going to

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a much bigger share of the G.O.P. base, and a solid majority of professional Republican politicians. Which brings me to the campaign against Obamacare after the 2016 election once again briefly gave the G.O.P. unified control of Congress and the White House. Republicans finally had the chance

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away from tens of millions, even the G.O.P. balked at the prospect. What was left was a campaign of sabotage: trying to undermine Obamacare by striking at its provisions in ways that didn’t too obviously take away people’s health insurance, but made insurance harder to get, more

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purely about hurting the act’s beneficiaries, and in some cases actually cost more money than leaving the act intact. The good news was that Obamacare’s architects built better than many, including myself, had realized. The law was hardly immune to sabotage, but it proved more robust than many had

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? I have no idea. But this seems like a good moment to review why Republicans can’t come up with a non-disastrous alternative to Obamacare. It’s not because they’re stupid (although they have become stunningly anti-intellectual). It’s because you can’t change any major element of

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. In states with G.O.P. governors, 21 percent of the population lives in such counties; in Democratic-governor states, less than 2 percent. So Obamacare is, though nobody will believe it, a well-thought-out law that works where states want it to work. It could and should be made

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in the number of uninsured? The answer is, all of them. After all these years of denouncing Obamacare, then, Republicans have no idea how to do better. Or, actually, they have no ideas at all. OBAMACARE’S VERY STABLE GENIUS April 9, 2018 Front pages continue, understandably, to be dominated by the

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what? Voters are right. If Republicans retain control of both houses of Congress, we can safely predict that they’ll make another try at repealing Obamacare, taking health insurance away from 25 million or 30 million Americans. Why? Because their attempts to sabotage the program keep falling short, and time is

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been remarkably stable when you bear in mind that it’s being administered by people trying to make it fail. What’s the secret of Obamacare’s stability? The answer, although nobody will believe it, is that the people who designed the program were extremely smart. Political reality forced them to

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did manage to create a system that’s pretty robust to shocks, including the shock of a White House that wants to destroy it. Originally, Obamacare was supposed to rest on a “three-legged stool.” Private insurers were barred from discriminating based on pre-existing conditions; individuals were required to buy

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), after-subsidy premiums have actually gone down for many people. And that leaves the G.O.P. very, very frustrated. From the beginning, Republicans hated Obamacare not because they expected it to fail, but because they feared that it would succeed, and thereby demonstrate that government actually can do things to

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another all-out push to destroy the act—because they’ll know that it’s probably their last chance. Indeed, if they don’t kill Obamacare soon, the next step will probably be an enhanced program that lets Americans of all ages buy into Medicare. So voters are right to believe

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can tell, the only Republican in Congress with anything resembling a spine. As a result, if Republicans hold Congress in November, they will indeed repeal Obamacare. That’s not a guess: it’s an explicit promise, made by Vice President Mike Pence last week. But what about the problems that sank

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particular, if you want to preserve protection for people with pre-existing conditions—the health issue that matters most to voters, including half of Republicans—Obamacare is the most conservative policy that can do that. The only other options are things like Medicare for All that would involve moving significantly to

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case in New York, where premiums for individual policies were very high before the A.C.A.—and promptly fell by half when Obamacare went into effect. For what Obamacare did was provide incentives to get healthy people to sign up, too. On one side there was a penalty for not having

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with the mandate, and have succeeded in driving premiums higher; but the system is still standing thanks to those subsidies. The point, again, is that Obamacare is the most conservative option for covering pre-existing conditions, and if Republicans really cared about the scores of millions of Americans with such conditions

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rate was still above 10 percent. What made the difference? Solid-blue California, with a Democratic governor and Legislature, did all it could to make Obamacare work: It expanded Medicaid, operated its own marketplace, and made major efforts to get people signed up. North Carolina, under Republican rule, did none of

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government plans—as alternatives to private insurance? The point is that while the new House majority won’t be able to do much beyond defending Obamacare, at least for now, its allies in the states can do much more, and in the process deliver on the agenda the whole party ran

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the revenue involved could be raised by fairly narrow-gauge taxes—in particular, taxes that hit only high-income Americans. That is, in fact, how Obamacare was financed: the revenue component came almost entirely from taxes on high incomes (there were some small items like the tax on tanning parlors). And

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. It was tested in 2013, when Barack Obama allowed some of the Bush tax cuts to expire, while raising some other taxes to pay for Obamacare; the economy just kept chugging along. It was, finally, tested by Donald Trump, who passed a big tax cut in 2017 amid promises of another

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deal in itself, but which add up to significant tax increases on almost two-thirds of middle-class taxpayers. Meanwhile, the bill would partially repeal Obamacare, in a way that would sharply reduce aid to lower-income families and raise the cost of insurance for many in the middle class. You

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more than limit misery: they can be liberating. I’ve known many people who stuck with jobs they disliked for fear of losing health coverage; Obamacare, flawed as it is, has noticeably reduced that kind of “lock in,” and a full guarantee of health coverage would make our society visibly freer

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the good. There are valid arguments for the superiority of a single-payer, Medicare for All–type health system over hybrid public-private alternatives like Obamacare. But in 2009, when there was the first real chance at health reform in fifteen years, it was clear that the country wasn’t ready

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appealing slogan, and hash out many of the details. You don’t want to be like the Republicans, who spent years talking big about repealing Obamacare, but never worked out a realistic alternative. So what does the Green New Deal mean? It’s not entirely clear, which is what makes it

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using executive action to cut taxes on the rich by an extra $100 billion. There’s also health policy, where Trump, having failed to repeal Obamacare—which would have been a huge blow to working families—has engaged instead in a campaign of sabotage that has probably raised premiums by almost

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important extent, a referendum on the Affordable Care Act; health care, not Donald Trump, dominated Democratic campaigning. And voters delivered a clear verdict: they want Obamacare’s achievements, the way it expanded coverage to roughly 20 million people who would otherwise have been uninsured, to be sustained. But on Friday, Reed

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Excels Ailing Health Care Health Care Confidential Health Care Terror The Waiting Game Health Care Hopes Fear Strikes Out Obamacare Fails to Fail Imaginary Health Care Horrors Three Legs Good, No Legs Bad Obamacare’s Very Stable Genius Get Sick, Go Bankrupt, and Die How Democrats Can Deliver on Health Care Running

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“hijacked” commission of, 198–200 and revenue growth, 225 stimulus plan of, 104, 107–8, 113–14, 115–17, 118–20, 131, 193, 206, 362 Obamacare, see Affordable Care Act O’Brien, Michael, 126 Ocasio-Cortez, Alexandria (AOC), 234, 236, 237, 320–21 Occupy Wall Street, 285 O’Connor, Reed, 367

Why We're Polarized

by Ezra Klein  · 28 Jan 2020  · 412pp  · 96,251 words

go on, as president, to create the Environmental Protection Agency, consider a basic minimum income, and propose a national health-care plan more ambitious than Obamacare—spoke with derision of those who sought to cleave the parties by their beliefs. “It would be a great tragedy if we had our two

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as Medicare was in both conception and execution, it received seventy Republican votes in the House as well as thirteen Republican votes in the Senate. Obamacare, by contrast, was modeled off Mitt Romney’s reforms in Massachusetts and built atop many Republican ideas;V it relied on private insurers for the

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bulk of its coverage expansion and ended up sacrificing its public option. But as compromised as Obamacare was in design, and as desperate as the Obama administration was for bipartisan support—and believe me, I covered that fight, they would’ve traded

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with the Democratic Party to create Medicare, a single-payer health-care system for the elderly. In 2010, not a single congressional Republican voted for Obamacare, a health-care plan based on the system Republican governor Mitt Romney designed in Massachusetts. Under any definition, the 2010 system was more sorted and

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politicians found themselves in the middle. But was the 2010 system more ideologically extreme? I’d argue, under our normal ideological definitions, it wasn’t—Obamacare was a public-private system with Republican roots that paid for itself through a mixture of tax increases and spending cuts, while Medicare was a

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now in favor of some sort of individual mandate.”8 This process led, eventually, to the Patient Protection and Affordable Care Act—better known as Obamacare—which also included an individual mandate. The bill was designed to be a compromise proposal, and for a time, it looked like it was. In

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reliable liberals to the court. Yet Republicans, more often than not, appoint justices who vote with the other side on critical decisions.”27 What the Obamacare case did convince many of was the waning legitimacy of the Supreme Court. The near success of what seemed like a ridiculous argument to liberals

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Kennedy and Roberts of motivated reasoning on behalf of the Court itself—they knew it would’ve been institutionally disastrous for the Court to overturn Obamacare, so they found an excuse to back down. And while I obviously find one of those arguments more persuasive than the other, I can’t

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tells us we can’t trust our own reason. How do we reason our way out of that? I first wrote about motivated reasoning and Obamacare’s individual mandate in 2012. In response to that piece, the psychologist Paul Bloom wrote an article in the Atlantic that didn’t quarrel with

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this gotcha: “notice that Klein doesn’t reach for a social-psychology journal when articulating why he and his Democratic allies are so confident that Obamacare is constitutional.”30 Bloom’s right, of course. But the implications are more radical than he seemed prepared to admit. The question isn’t whether

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entire issue more fully and evenhandedly,” the researchers concluded. III. I should note that this fight is ongoing. Republicans subsequently took Congress, failed to repeal Obamacare, but changed the law so the mandate’s penalty was zero dollars. Then, a group of Republican attorneys general launched the Texas v. Azar case

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proves is that in the Obama era, attitudes on race began shaping attitudes on virtually all political questions. The black-white divide in support for Obamacare was 20 percentage points larger than the black-white divide over Bill Clinton’s similarly controversial health-care proposal, for instance. But it wasn’t

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around Supreme Court nominations. Deeper political divides are leading to more partisan cases: consider the Right’s multiyear effort to convince the Court to destroy Obamacare, a campaign with no corollary in the aftermath of, say, Medicare’s or Medicaid’s passage. Partisan disagreement and paralysis in Congress are making the

…

a laser-like focus on Cornhusker interests. But he was in a bind. The choice on Obamacare was yes/no. Democrats needed his vote to pass the law. Nelson wanted the law to pass. But Obamacare was unpopular back home, and Nelson was up for reelection in 2012. He was caught between

…

career, his party, and his conscience. Nelson’s solution was to split the ideological interests of Nebraska’s Republicans from the financial interests of Nebraskans. Obamacare’s Medicaid expansion was built with an unusual structure. Typically, Medicaid is funded by a roughly 60:40 split between the federal government and the

…

or paralysis? I choose governance, in part because I trust the American people to ultimately look out for their own interests. Democrats who worry that Obamacare would’ve been repealed in the absence of the filibuster give too little credit to a country that would’ve noticed health care being canceled

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, 76–77 “access-oriented” donors, 189 Achen, Christopher, 94, 95 activism, identity and, 156 Adams, John, 11 advertising, culture reflected in, 112 Affordable Care Act (Obamacare; 2010), 5, 15, 33, 83, 98–99, 101, 109, 182, 207–9, 212, 256 African Americans, 20, 117, 230–31 bias against, 34, 114 disenfranchisement

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emblematic of change, 103 Garland nomination by, 198–99, 203–4 media coverage of, 165–66 polarization paradox of, 65–70 Senate run of, 185 Obamacare, see Affordable Care Act Obama presidency, 14–15, 105, 113, 132, 134, 195, 228 coalition of, 136 end of, 114, 120–21, 134 as racially

Listen, Liberal: Or, What Ever Happened to the Party of the People?

by Thomas Frank  · 15 Mar 2016  · 316pp  · 87,486 words

years, but there have also been exceptions to it—big ones. The one great achievement of Obama’s presidency, the health insurance reform known as “Obamacare,” has many flaws, but it also subsidizes the purchase of coverage by people who otherwise can’t afford it. This detail was an important victory

…

for the poor—and also a measure without which Obamacare could not accomplish the other things it does, such as stopping insurers from cancelling sick people’s insurance. Another triumph was the establishment of a

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Max Baucus, Democrat of Montana, a notable friend of the lobbyist and (as of this writing) the U.S. ambassador to China. Instead we got Obamacare, with its exchanges, its individual and employer mandates, its Cadillac tax, its subsidies to individuals and to the insurance industry, and its thousands of other

…

), or whether it will truly make health care more affordable. In a video clip accessible on YouTube, Democratic Senator Jay Rockefeller can be seen describing Obamacare as “the most complex piece of legislation ever passed by the United States Congress”; a former state health-insurance official in Massachusetts, whose health care

…

made it 10 times more complex.”1 Why did Team Obama choose to go this route? One explanation is suggested by the infamous remarks of Obamacare consultant Jonathan Gruber, an MIT economist who was videotaped telling an academic conference in 2013 that the law was deliberately “written in a tortured way

…

is designed to make outside scrutiny difficult if not impossible. Why not here, too? Had fairness and greater equality been the primary goals of either Obamacare or Dodd-Frank, they would no doubt have been far more straightforward. But complexity allowed Obama to square the circle of modern liberalism. It allowed

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. A single-payer system would obviously have done grave damage to the insurance industry, while a public option would have given it unwelcome competition. But Obamacare did the opposite—it made those insurers into a permanent feature of the economic landscape. Their enthusiasm for the measure was obvious and much discussed

…

at the time, as was that of Big Pharma: Obamacare essentially made our patronage of these industries mandatory. A forgotten school of left-wing historians used to argue that the regulatory state began not with

…

, a standardized phone system. But its main objects were stability for existing businesses and guaranteed profits in perpetuity.3 Certain events surrounding the advent of Obamacare have resurrected this scary hypothesis. In the summer of 2009, PhRMA, the lobby of the big pharmaceutical companies, aggressively supported the president’s health care

…

an enormous controversy and can be watched on the website of the Washington Post: https://www.washingtonpost.com/news/post-politics/wp/2014/11/11/obamacare-consultant-under-fire-for-stupidity-of-the-american-voter-comment/.   3. The main proponent of this viewpoint was Gabriel Kolko, author of The Triumph of

…

search for terms of interest. For your reference, the terms that appear in the print index are listed below. ABInBev Ackman, William Affordable Care Act “Obamacare” (2009) Afghanistan AFL/CIO Agenda, The (Woodward) Aid to Families with Dependent Children (AFDC) AIG Airbnb Alexander, Michelle Allen, George Allen, Paul All in the

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many, many queries to him. Jeff Schmidt helped me comprehend professionalism; Zillah Eisenstein had special understanding of the character of Hillary Clinton; Brendan Williams explained Obamacare to me; Milford Bateman walked me through the disasters of microfinance; Barry Lynn helped me understand antitrust; Bill Black knew about Dodd-Frank and the

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Bureaucracy

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Data-Ism: The Revolution Transforming Decision Making, Consumer Behavior, and Almost Everything Else

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How to Talk to a Science Denier: Conversations With Flat Earthers, Climate Deniers, and Others Who Defy Reason

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Last Best Hope: America in Crisis and Renewal

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The Lords of Easy Money: How the Federal Reserve Broke the American Economy

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Freedom Without Borders

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A Book for Her

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WTF?: What's the Future and Why It's Up to Us

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Augmented: Life in the Smart Lane

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Licence to be Bad

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Confessions of a Crypto Millionaire: My Unlikely Escape From Corporate America

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The Man Who Solved the Market: How Jim Simons Launched the Quant Revolution

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Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity

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Trick Mirror: Reflections on Self-Delusion

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A Year of Living Danishly: My Twelve Months Unearthing the Secrets of the World's Happiest Country

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Pax Technica: How the Internet of Things May Set Us Free or Lock Us Up

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Disaster Capitalism: Making a Killing Out of Catastrophe

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The Extreme Centre: A Warning

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Powerhouse: The Untold Story of Hollywood's Creative Artists Agency

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Hillbilly Elegy: A Memoir of a Family and Culture in Crisis

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After the Fall: Being American in the World We've Made

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Markets, State, and People: Economics for Public Policy

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Why Nothing Works: Who Killed Progress--And How to Bring It Back

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Limitarianism: The Case Against Extreme Wealth

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Doing Time Like a Spy

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What's the Matter with White People

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The Great Race: The Global Quest for the Car of the Future

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The Health Gap: The Challenge of an Unequal World

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Superforecasting: The Art and Science of Prediction

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Free Speech: Ten Principles for a Connected World

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The Evolution of Everything: How New Ideas Emerge

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The Rich and the Rest of Us

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What Went Wrong: How the 1% Hijacked the American Middle Class . . . And What Other Countries Got Right

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The Upstarts: How Uber, Airbnb, and the Killer Companies of the New Silicon Valley Are Changing the World

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But What if We're Wrong? Thinking About the Present as if It Were the Past

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Miracle Cure

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Educated

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The Light That Failed: A Reckoning

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Small Men on the Wrong Side of History: The Decline, Fall and Unlikely Return of Conservatism

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The Death of Truth: Notes on Falsehood in the Age of Trump

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The Quiet Damage: QAnon and the Destruction of the American Family

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Eastern USA

by Lonely Planet

Economists and the Powerful

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The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America

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The Mission: A True Story

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Nomad Capitalist: How to Reclaim Your Freedom With Offshore Bank Accounts, Dual Citizenship, Foreign Companies, and Overseas Investments

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The Upswing: How America Came Together a Century Ago and How We Can Do It Again

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The Secret Life of Groceries: The Dark Miracle of the American Supermarket

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Dark Matters: On the Surveillance of Blackness

by Simone Browne  · 1 Oct 2015  · 326pp  · 84,180 words

The Meritocracy Myth

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Dreamland: The True Tale of America's Opiate Epidemic

by Sam Quinones  · 20 Apr 2015  · 433pp  · 129,636 words

Lost at Sea

by Jon Ronson  · 1 Oct 2012  · 375pp  · 106,536 words

Better, Stronger, Faster: The Myth of American Decline . . . And the Rise of a New Economy

by Daniel Gross  · 7 May 2012  · 391pp  · 97,018 words

India's Long Road

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Dream Hoarders: How the American Upper Middle Class Is Leaving Everyone Else in the Dust, Why That Is a Problem, and What to Do About It

by Richard V. Reeves  · 22 May 2017  · 198pp  · 52,089 words

The Space Barons: Elon Musk, Jeff Bezos, and the Quest to Colonize the Cosmos

by Christian Davenport  · 20 Mar 2018  · 390pp  · 108,171 words

How Did We Get Into This Mess?: Politics, Equality, Nature

by George Monbiot  · 14 Apr 2016  · 334pp  · 82,041 words

Twitter and Tear Gas: The Power and Fragility of Networked Protest

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Live Work Work Work Die: A Journey Into the Savage Heart of Silicon Valley

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Give People Money

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Seasteading: How Floating Nations Will Restore the Environment, Enrich the Poor, Cure the Sick, and Liberate Humanity From Politicians

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Hard Times: The Divisive Toll of the Economic Slump

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A Pelican Introduction Economics: A User's Guide

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Messing With the Enemy: Surviving in a Social Media World of Hackers, Terrorists, Russians, and Fake News

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New Power: How Power Works in Our Hyperconnected World--And How to Make It Work for You

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American Gun: The True Story of the AR-15

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Radicalized

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No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy

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Free Money for All: A Basic Income Guarantee Solution for the Twenty-First Century

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Hustle and Gig: Struggling and Surviving in the Sharing Economy

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We Need New Stories: Challenging the Toxic Myths Behind Our Age of Discontent

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Don't Burn This Book: Thinking for Yourself in an Age of Unreason

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The Startup Way: Making Entrepreneurship a Fundamental Discipline of Every Enterprise

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The Euro and the Battle of Ideas

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Straphanger

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Termites of the State: Why Complexity Leads to Inequality

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If Mayors Ruled the World: Dysfunctional Nations, Rising Cities

by Benjamin R. Barber  · 5 Nov 2013  · 501pp  · 145,943 words

Why America Must Not Follow Europe

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Pity the Billionaire: The Unexpected Resurgence of the American Right

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USA Travel Guide

by Lonely, Planet

When to Rob a Bank: ...And 131 More Warped Suggestions and Well-Intended Rants

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