John McDonough has written a definitive book on the Affordable Care Act of 2010, better known as ObamaCare; he was intimately involved in its creation; and he probably knows the 800-plus-page law as well as anyone alive. But could he handle the 3-minute challenge?
I figure the typical human response to talk of the complexity and enormity of the 18-month-old federal health reform law is for the brain to shut down within three minutes. So that’s the limit I gave John, a professor at the Harvard School of Public Health, for explaining what’s most important to know about what’s happening with national health reform now. My favorite line: “As a result [of the law], there is probably more innovation and change going on in our health care system than in anyone’s living memory.”
I’d like to pretend that he just didn’t quite make it in three minutes, but in fact, my Flip camera inexplicably shut down at just about the three-minute mark (no wonder they were discontinued), so below is what he would have said if not so rudely interrupted:
…and because the law is a landmark law, that really can only be legitimately contrasted with the 1935 Social Security Act and the 1965 Medicaid and Medicare act, it is a landmark law that is replete with numerous smaller landmarks in there, including on elder justice — a whole new national framework addressing abuse and exploitation of seniors — and the Indian Health Reauthorization Act to modernize the Indian Health Service.
There are so many examples people have no idea are in there — calorie labeling in restaurants — there’s just so much here. What I find as I talk about this around the country is that everybody has an opinion about the law, everybody has their mind made up, and almost nobody has a broad understanding of what the law is and what it does.
So what I try to do in the book is help people understand the law’s essential broad architecture to get a sense of the whole. Because everybody’s heard of calorie labeling, the individual mandate, lifetime benefit limits, but people lack a sense of the whole scope and ambition of the law. And not in a way to say you should love it or hate it, but you should, if you can, try to understand it, particularly with the stakes so high leading up to Nov. 6, 2012.
The book, “Inside National Health Reform,” is garnering rave reviews, including here on the Incidental Economist blog. The blog’s Austin Frakt describes the book as a great mix of spinach and sugar, which might be bad culinarily but works well intellectually:
As you can no doubt tell from my recent posts, I found a lot to like in John McDonough’s Inside National Health Reform.* I’ve now read the whole thing.
It’s really two books in one. The first is the story of the politics of getting to reform. The second is the story of the law itself, what it says and what it means. I’ll bet you’re thinking the first part is (political) mind candy, the second spinach. You’re half right. McDonough was (is) a true insider, having served as senior adviser to the Senate Committee on Health, Education, Labor and Pensions, which granted him access to many crucial meetings and key individuals. He put his inside knowledge to use in the first part of the book, where you’ll find many of the quotes I posted while reading.
The second part, which explains the actual law, surprised me. I expected a dry recounting of the gist of titles, subsections, amendments, etc. That would be boring. I expected I’d skip most of it, since I’ve read the law and summaries of it already. But that’s not what McDonough did. Well, yes, he did recount what the law says, but he broke it up with long passages explaining how key portions of the bill came together politically and how they fit into the context of the US health system.
It was a brilliant idea, to interleave bits of spinach with shots of sugar. It worked. (Indiana State Fare food vendors, take note!)