An insider’s account of the historic passage of Obamacare.
Debut author Williams was a three-term Democratic state representative and the deputy to the insurance commissioner of Washington state, so he’s well-positioned to write a book about the creation, passage, and aftermath of the 2010 Patient Protection and Affordable Care Act. He begins with a reflection on the contentious state of political affairs regarding health care: how did a powerful, idealistic Democrat-controlled Congress produce such an unpopular, unwieldy piece of legislation? And how was the original ideal of a single-payer system abandoned so quickly and thoroughly? Williams walks readers through the labyrinth of political compromises that ultimately diluted the original reformist spirit of the ACA and, in his view, rendered it a dubious achievement. His analysis is consistently rigorous, and it’s particularly strong when it turns to complex issues such as state-run health insurance exchanges; his insider knowledge of Washington state gives him a clear perch from which to appraise its experiments in making the ACA work. He also makes a credible, nonpartisan effort to pinpoint the law’s structural inadequacies and details how rampant dishonesty about the ACA undermined the public’s already shaky trust in government: “what sort of protection was a policy that, even after a tax subsidy toward premiums, required a $6,600 deductible before care could even be accessed?” Overall, Williams’ examination might prove too wonkish for average readers; not many will relish an extended discussion of “medical loss ratios,” for example. But for those who want a detailed investigation into the internal machinations of the ACA, this is a well-documented assessment. Williams can be reductive when he interprets the opportunistic motives of politicians with whom he disagrees. However, he proves to be a more than competent guide through the murkiest of legislative waters.
A fair, rigorous take on health care reform in the United States.