I was recently invited to review Steven Brill’s book on health reform, America’s Bitter Pill, for the quarterly journal Democracy.
As someone who came started following the reform debate relatively late—after the ACA had been passed—I thought the book offered a rich and useful political history of the law. The policy recommendations at the end of the book left me a bit perplexed, though.
On the first day that the federal insurance exchange was online, just six people were able to register for coverage. The site struggled to work for months. But when open enrollment finally ended in April 2014, after several extensions from the Administration, more than eight million people had found coverage through the state and federal insurance exchanges, surpassing projections from the Congressional Budget Office. In America’s Bitter Pill, Steven Brill deftly chronicles this disaster and recovery with a depth of reporting that day-to-day coverage didn’t provide. With the benefit of hindsight and the space of 455 pages of text, Brill is able to trace the stubborn and complex confluence of pressures, inescapable trade-offs, and fallible actors that brought us the nation’s most sweeping health reform in half a century.
But Brill, the celebrated investigative journalist, proves to be fallible, too: Rather than stick to reporting, he chooses to play pundit and issue ill-informed prescriptions for our health-care system. His recommendations demonstrate a certain hubris about our understanding of the system’s failures—a hubris that is all too commonplace in political rhetoric around health reform.
Go read the rest here.