Once upon a time, the Affordable Care Act (ACA) was unpopular, seen by many as a redux of well-being. Barack Obama promises that if you love your health care plan, you will be able to keep your health care plan, it didn’t exactly work. By the mid-2010s, the so-called Obamacare cost Democrats both houses of Congress.
Yet with a great recession and pandemic raging later, the ACA is loved, if not necessarily loved, by a majority of Americans.
The political process doesn’t stop just because a bill becomes law, according to Jonathan Cohn.
As if to prove Cohn’s point, the United States is awaiting a Supreme Court ruling on another Obamacare challenge, this one brought by the Trump administration and Republican attorneys general. If they win, more than 20 million Americans risk losing their health coverage. Nearly half a million have died from Covid. Markets do not always provide what is needed.
The Ten Years War is a throwback to the crusade for universal health coverage and a sequel to Cohens’ previous book, Sick: The Untold Story of Americas Healthcare Crisis. Cohn is a senior correspondent for the Huffington Post. His grip remains informed and nuanced, not breathless. The Ten Years War also captures the bitter and tectonic changes in American politics.
Cohn convincingly argues that anti-health care fighters have operated with less than perfect knowledge, and that preconceived beliefs have too often clouded their judgment. Cohn targets both political freaks and politics junkies. Laced with interviews and quotes from both sides of the aisle, his book is definitely newsworthy.
Obama and Tom Price, Donald Trump, Short-Term Health Secretary, are officially speaking. David Axelrod, adviser to Obamas, and Michael Carvin, a veteran conservative lawyer who has argued unsuccessfully against the constitutionality of Obamacares, also speak to the author. Years earlier, in the 2000 election, Carvin was brief about George W. Bush who won the bet in the Supreme Court.
There were those who suggested we shouldn’t be doing anything other than saving
Obama admits his surprise that Republicans did not budge after the passage of ACA, unlike Medicare in 1965 under Lyndon Johnson. We didn’t agree to any of that, he said. The unsaid is that blue and red are more than just colors, they are tribes.
To the same extent, Obama recognizes that some have suggested that we should be doing nothing other than economics. This is an understatement.
One of those foreigners was Chuck Schumer, now Senate Majority Leader. Even so, Cohn writes, the New Yorker grasped the all-in-one’s political consequences for health care amid the collapsing job and housing markets.
Indeed, after the Democrats lost the Senate in 2014, the senior senator from New York unloaded on Obama in front of the National Press Club: after passing the stimulus, the Democrats should have continued to offer programs oriented towards the middle class. Stated differently, the ACA pointed to the inherent instability of the Democratic coalition on the lower tier.
Instead, as Schumers recounts, we took their tenure and put our full attention on the bad problem of health care reform. Apparently, there are few things more rewarding in politics than saying to a sitting president: I told you.
Of course, political myopia is not the only province of one party. Price admits Republicans also operated in their own universe.
I think there was a lack of appreciation from all of us in the administration as to the difficulty of repealing Obamacare, he said. Price is a physician and former congressman from Georgia.
Price criticizes Trump for shaping his policy to be the last voice to whisper in his ear, and for a fundamental lack of understanding of health care and insurance.
We would make concrete decisions on what we were going to do, he said, get presidential approval, and then within 24 hours the decision would change.
For the price boss, removing the mat from under others was standard operating procedure.
John McCain leaves the Senate after voting against the GOP Skinny Repeal health care bill. Photograph: Justin Sullivan / Getty Images
According to recent reports, Steve Bannon, then in the White House, believed Trump was demented by dementia and should have been kicked out. That did not happen, but Price left the government amid a flurry of controversy surrounding his use of taxpayer funds to fund private jet travel.
No book on Obamacare would be complete without a late-night John McCains tale on Senate floor. Here, Cohn definitely delivers. Adding to the legend, Cohn relays the Arizonians’ loss of patience with Senator Lindsey Graham, his longtime winger who was already turning into Trump’s sidekick.
Hours before McCain dealt a fatal blow to the repeal of the ACA, he appeared at a press conference with Graham to discuss the latest administration-backed ploy. As Cohn said, McCain didn’t seem to pay attention to what Graham was saying. A Republican aide saw what was going on, Cohn reports, and speculated that McCain had come to believe this thing is so stupid I have to kill it.
More than five in nine Americans believe it is the responsibility of the federal government to ensure that all Americans have health coverage, a level of support that is actually lower than 15 years ago. In the 2020 Democratic primaries, Joe Biden was the only prominent candidate to oppose both Medicare for All and efforts to end private health insurance.
He also understood the Democratic Center better than Bernie Sanders or Elizabeth Warren. The core of the party wanted reassurance, not Massachusetts socialism or McGovernism. None of the senators would have beaten Trump, Utopia could wait.
When Biden, as Obamas’ vice president, exclaimed that the ACA was a fucking big deal, he tacitly acknowledged that Obamacare had pushed the boundaries of what was doable. To quote Cohn, in America, this is what change looks like.
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