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A review by mancolepig
America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System by Steven Brill
4.0
We’ve swallowed a bitter pill indeed, considering how divisive, controversial, and in many ways, utterly ineffective the Affordable Care Act is. Steven Brill leaves no stone unturned in his balanced investigation of the bill’s history, passage, and implementation over 6 or 7 years in Washington D.C. This makes the book a bit of a slog with its meticulous recordings of email correspondances and meetings, and its cast of thousands of congressmen, senators, aids, department heads, lobbyists, doctors, and insurance salesmen. But it is worth wading into the swamp to see what Washington “deal-making” really entails, and how that deal-making has affected our country’s healthcare crisis. Or hasn’t. I’ll leave the nitty gritty details to Brill, but I’ll give you a few of my conclusions:
First of all, everyone’s a hypocrite. President Obama and the Democratic legislators made and broke many of the promises that Republicans have been slamming them for ever since. They did indeed make backroom deals with lobbyists to protect corporate interests for pharmaceuticals and insurance companies among others, and they rammed a poor patch job of a bill all the way through to the top without bipartisan support as talks with Republicans gradually broke down. Of course the Republicans were no saints either, refusing to admit that Obamacare was based on a Republican idea (Massachusetts’s Romneycare) and using the benefits of the bill while publicly calling for its demise. Brill particularly nails Mitch McConnell, who has been one of Obamacare’s harshest critics while simultaneously promising to keep Kentucky’s successful healthcare marketplace: Kynect. As Brill astutely points out, Kynect would never have existed if not for Obamacare.
Second of all, this bill is a mess. There is no single payer, no public option for insurance (In other words, we are forced to buy a product from a private company or face having to pay a mandate to the government), and pharmaceuticals can still set pill prices however they damn well please, even though every other developed nation on Earth has strict regulations and negotiating powers. I get incensed over this because pharmaceuticals have made it ILLEGAL for Americans to buy cheaper drugs from Canada (Who has much more effective regulations on prices), and they have also made it ILLEGAL for the government to negotiate for discounted prices. Combine that with pharmaceutical patents that don’t expire for years, and these scumbags can charge $1000 PER PILL (In the case of Sovaldi) while their CEOs make upwards of $13 million per year plus stock options. But that’s what happens when you let lobbyists write laws. Obamacare really bombed there.
Third and finally, this bill (I guess I should say law) is a mess but it gives me hope. As we saw with the attempts to repeal this law in the past year, the genie is out of the bottle, and even a Republican controlled government could not erase its impact. It turns out that people like having healthcare, and if Obamacare did nothing else it gave millions of Americans a chance to afford that healthcare. On a personal note, I have a close friend who was able to get Medicaid while she was looking for full-time employment thanks to Obamacare and Governor Kasich’s choice to expand Medicaid in Ohio. I don’t think this law “fixed” our broken healthcare system, and taxpayers will be footing a lot of the bill, but you can’t deny that it has truly helped a lot of people get the coverage they need.
Brill offers some ideas on how to make the fixes we need. Honestly, I’m not sure his ideas will work, and I don’t know that making fixes to the law will even be possible in Washington’s current state. Republicans want a repeal or bust, and Democrats are ready to defend the law to the death. Meanwhile the insurance companies, device makers, and Pharmaceuticals keep raking in the publicly-funded profits, but on the plus side I feel that I understand the law so much better now than I did before, and I’d recommend this book to anyone who feels confused about it. It’s a long book but so much more understandable than the 1,000 pages of the Affordable Care Act’s actual text.
First of all, everyone’s a hypocrite. President Obama and the Democratic legislators made and broke many of the promises that Republicans have been slamming them for ever since. They did indeed make backroom deals with lobbyists to protect corporate interests for pharmaceuticals and insurance companies among others, and they rammed a poor patch job of a bill all the way through to the top without bipartisan support as talks with Republicans gradually broke down. Of course the Republicans were no saints either, refusing to admit that Obamacare was based on a Republican idea (Massachusetts’s Romneycare) and using the benefits of the bill while publicly calling for its demise. Brill particularly nails Mitch McConnell, who has been one of Obamacare’s harshest critics while simultaneously promising to keep Kentucky’s successful healthcare marketplace: Kynect. As Brill astutely points out, Kynect would never have existed if not for Obamacare.
Second of all, this bill is a mess. There is no single payer, no public option for insurance (In other words, we are forced to buy a product from a private company or face having to pay a mandate to the government), and pharmaceuticals can still set pill prices however they damn well please, even though every other developed nation on Earth has strict regulations and negotiating powers. I get incensed over this because pharmaceuticals have made it ILLEGAL for Americans to buy cheaper drugs from Canada (Who has much more effective regulations on prices), and they have also made it ILLEGAL for the government to negotiate for discounted prices. Combine that with pharmaceutical patents that don’t expire for years, and these scumbags can charge $1000 PER PILL (In the case of Sovaldi) while their CEOs make upwards of $13 million per year plus stock options. But that’s what happens when you let lobbyists write laws. Obamacare really bombed there.
Third and finally, this bill (I guess I should say law) is a mess but it gives me hope. As we saw with the attempts to repeal this law in the past year, the genie is out of the bottle, and even a Republican controlled government could not erase its impact. It turns out that people like having healthcare, and if Obamacare did nothing else it gave millions of Americans a chance to afford that healthcare. On a personal note, I have a close friend who was able to get Medicaid while she was looking for full-time employment thanks to Obamacare and Governor Kasich’s choice to expand Medicaid in Ohio. I don’t think this law “fixed” our broken healthcare system, and taxpayers will be footing a lot of the bill, but you can’t deny that it has truly helped a lot of people get the coverage they need.
Brill offers some ideas on how to make the fixes we need. Honestly, I’m not sure his ideas will work, and I don’t know that making fixes to the law will even be possible in Washington’s current state. Republicans want a repeal or bust, and Democrats are ready to defend the law to the death. Meanwhile the insurance companies, device makers, and Pharmaceuticals keep raking in the publicly-funded profits, but on the plus side I feel that I understand the law so much better now than I did before, and I’d recommend this book to anyone who feels confused about it. It’s a long book but so much more understandable than the 1,000 pages of the Affordable Care Act’s actual text.