Book Review: America’s Bitter Pill

“‘In hindsight,’ [Obama] told me, ‘there should have been one central person in charge, a CEO of the Marketplace.'”
This sentence summarizes the debacle of implementing kynect, the online marketplace that would showcase the glory of the Affordable Care Act (or Obamacare). It is incredibly difficult to provide a comprehensive view of all the issues pre- and post-implementation of the act, and while Steven Brill makes a valiant effort, the key story line gets lost in the stats and politics of Washington.
When I began this book, I hoped to get a holistic view of the ACA: what were the existing solutions, what it attempted to change, and what was ultimately implemented. Brill, in his attempt to show that everyone had the best intentions in the beginning, writes about almost every key provision that was added, discussed, or even suggested in passing, no doubt to show everyone had the best of intentions. In truth, the book’s focus should have been on what conditions the administration could control, and what went wrong.
The ACA had 2 major issues that slowed its momentum to a crawl: the online marketplace, and the promise of keeping your existing policy. Without the momentum, it had to fend off attacks from its critics and, subsequently, a large portion of citizens (despite benefiting a number of them). The online marketplace was tasked to a pre-approved government contractor and had something like 13 offices supervising its creation without a leader. Obama promised people could keep their existing policy (if they liked it) on June 2009, and NBC accurately rebutting the promise on October 2013.
It reads like 5 business cases rolled into 1: without a focus on execution, the rollout was doomed to fail. CGI (the chosen contractor), despite all its reports that it was on schedule, had miserably failed to put together a workable product (though, in all fairness, not entirely its fault). The administration’s spin city was out in full force, but had paid no attention to what was actually written (the grandfather clause was not the only discrepancy). The lack of expertise as well as fear of communicating upward left everyone in a state of shock when it was finally time to produce the finished service.
The book is written in a very linear fashion; the payoff doesn’t come until you’ve read 4/5ths of the book, when kynect is finally implemented. In the meantime, Brill spends every chapter cramming in intended acts, unintended consequences, perceived damage control, and human stories; all the while, the opponents circle, like sharks around a tightrope walker. Interesting facts and stories, which merit their own books, become part of a deluge of information for information’s sake. Perhaps the book itself is a statement of health insurance in this country.


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