I have a review in The American Prospect of Jonathan's Cohn's inside-the-creators' heads chronicle of the ACA's embattled formation and enactment:
Jonathan Cohn, a leading contemporaneous chronicler of the ACA’s formation and enactment, and now author of The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, is well aware of these shortcomings and faulty assumptions, as well as of the law’s resilience and partial success, such as reducing the uninsured population by about 35 to 40 percent. The book’s chief value, for me at least, lies in illuminating the creators’ perspectives at various crunch points in the law’s conception and enactment.
Cohn takes us back to a long time ago, in a galaxy far, far away, in which Democrats still hoped to win Republican support for major legislation...
The nuance with which Cohn captures the various players' assumptions and motives, and the pressures brought to bear on them, provides some real retroactive clarity, from what already feels like a substantial historical distance. I hope you'll read the review, which relies on substantial excerpts.
One side note. With implicit you-had-to-be-there empathy, Cohn (who was there) chronicles various misconceptions and missteps by Obama -- as well as documenting Obama's persistence at various points where the pressure was intense to table or pare back the legislation that became the ACA. I have spotlighted some of those missteps in recent posts, as well as in the review. But then again...early on, Cohn flashes a light on who we had as president. After chronicling a debate during the 2008 transition in which it appeared that the question of whether to pursue universal coverage was very much up in the air, Cohn concludes:
As for Obama, some of the people closest to him said they never doubted he would pursue comprehensive health reform right away. They said it was simply his style to hear out all arguments, to ask people to challenge him. They noted that he especially liked seeking out younger advisers who had done enough research to form an opinion but might shy away from expressing it, because they were more junior; he thought that was a good way to encourage diversity of opinion.
When I read that, the tears flowed. Looking back through the wreckage of the Trump years, it brought back not only what Obama is, but what he thought America was -- the political system and polity that he thought he could steer to a new birth of freedom and shared prosperity.
Maybe ultimately he will prove to have done so to a degree, as maybe the ACA will evolve into a healthcare system that provides affordable care to all. We have a second chance now, and Biden, and the bare Democratic majority in Congress, appear to have learned from the mistakes of the Obama era, determined neither to credit Republican criticism nor wait for Republican buy-in. Meanwhile, though, fascism stalks the land, and is stacking the electoral deck in dozens of state legislatures nationwide with a wave of voter suppression legislation that recalls the late-nineteenth century rollback of Reconstruction in the south. It's hard to be optimistic about democracy when one of two major parties has given up on it.
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