The full title of Steven Brill’s revealing text is “America’s Bitter Pill:  Money, Politics, Backroom Deals, and the Fight to Fix our Broken Healthcare System”. For those in the anti-Obama crowd who are assuming that the “bitter pill” is Obamacare (ACA), you will be deeply disappointed. In a similar vein, those in the pro-Obama legions will have to live with the author’s take-down of the president who is not without fault. Given these caveats, what then is the “bitter pill”? It’s our healthcare system, which Brill repeatedly refers to as a “jalopy”, and all the machinations that were involved in trying to apply much-needed reform to it.

Noting that Republicans had done absolutely nothing towards said reforms, Brill credits Obama and the Democrats for at least trying. They began with the best of intentions and there are parts of the resulting ACA that the author lauds (e.g. more affordable healthcare for millions of uninsured, no denial of coverage for pre-existing conditions, children can remain on their parents’ policy until age 26). In sharp contrast, he peels off the festering scab of conservatives’ lies, distortions and campaigns of misinformation, all devoted to killing the legislation in its “crib”.

For Brill, what starts out as a promising, noble enterprise quickly gets contaminated by the arrival and impact of lobbyists on the drafting of the ACA. Time and again, compromises were written into the emerging document to get various special interests and their congressional representatives on board. But, as evidenced by the final Senate and House votes, none of this wheeling and dealing convinced a single congressional Republican to support the bill. However, the aforementioned compromises remained firmly in place.

To tease out all this recent history, Brill interviewed over 230 individuals, including the president, and many of the other key players. His facts are carefully sourced, and each chapter has its own set of end-notes. There is an appendix that contains a verbatim account of the questions Brill put to the president, and the latter’s written responses. All these features contribute to the judgment that this book is a solid, credible piece of reportage.

Finally, the author expresses little hope that the political will and present climate exist for amending the ACA to improve it. He sees single-payer, national healthcare as a better alternative. But, he believes that to really fix the “jalopy”, we need drastic changes that would involve removing insurance companies as “middle men” between patients and providers. Such a move is worthy of consideration – patients want the best care and providers want to offer it. But that straightforward arrangement gets thrown out of whack by insurers who are constantly looking for ways to cut down on the number of claims, their size, and the amounts actually reimbursed to involved parties. Whatever happens, Brill asserts that it had better bend the healthcare cost cure downward because right now, it is using up far too much of our gross national product; certainly a great deal more than occurs in other developed countries. Brill agrees with the president’s assertion that we are on an unsustainable path, but does not believe that the ACA will solve that problem.

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1. Brill, Steven; America’s Bitter Pill” Money, Politics, Backroom Deals, and the Fight to Fix our Broken Healthcare System. New York:  Random House; (2015).

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