Nine Ways to Really Fix Obamacare

In Healthcare On

Steven Brill is the author of “America’s Bitter Pill: Money, Politics, Backroom Deals, And The Fight to Fix Our Broken Healthcare System.” He has received consulting fees for work on a consumer information and ombudsman program for New York-based Oscar Health Insurance.

If Senate Majority Leader Mitch McConnell cannot salvage his party’s effort to repeal and replace the Affordable Care Act, there is still a way forward if he and his Democratic colleagues truly want to fix Obamacare. All they have to do is be willing to compromise — and to acknowledge some history.

The failure of the Republicans to agree, so far, on an alternative to Obamacare should not be surprising — because Obamacare was, in fact, the long-standing Republican alternative to the more radical health-care reforms, such as a single-payer system, that Democrats have proposed since the Truman era. What President Barack Obama and his party pushed through Congress in 2010 was more conservative — and more pro-private sector — than what Richard M. Nixon proposed in the 1970s, or what Republican Gov. Mitt Romney implemented in Massachusetts in 2006. Put simply, Obama dared Republicans to take yes for an answer. In a polarized America, they still said no.

Obamacare did little to deal with the problem of health-care costs. There would be no cost-control interference with the only-in-America profits of drug companies, medical device makers or hospitals. Instead, the law subsidized Americans who could not otherwise afford health insurance, allowing them to become paying customers in the same overpriced private-sector system.

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‘America’s Bitter Pill,’ by Steven Brill

But in Brill’s new book, “America’s Bitter Pill,” his fresh, outsider curiosity makes him a superb guide to the maze of issues in American health care and health care reform. He breaks down insider language, asks fundamental and surprising questions, and leaves the reader — at least this one — full of more questions yet with a much clearer map of the lines of debate. You may not be persuaded by his conclusions, but you’ll emerge with a broader understanding of the characters and questions shaping our health care system.

“America’s Bitter Pill” is an energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy. It is full of insights, contradictions, apologias, flashes of anger, tidbits of history, extended stories of awe, compassion, some glibness and moments of brilliance. Above all, it includes fascinating reporting on how crucial decisions were made involving the drafting and implementation of the Affordable Care Act.

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