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What Steven Brill gets wrong about PPACA

A substantial amount of skepticism, perhaps even within the White House, existed about whether the health care legislation did enough on costs.

By Peter Orszag | Updated on January 13, 2015
(AP Photo/Don Ryan)
(Bloomberg View) — Steven Brill’s new book about the process of passing the Patient Protection and Affordable Care Act is so meticulously reported, I found myself surprised by many details of a process I myself was deeply involved in. I learned from “America’s Bitter Pill,” for example, that in October 2009 one of my White House colleagues apparently wrote a memo arguing that I had mislead President Barack Obama in highlighting the potential for the legislation to slow the growth of health care costs. Brill approvingly quotes a staff member saying that the point of the memo was that “Peter overstated to the president how great the bill was on costs.”

If the reporting is accurate, the anecdote is not just surprising but also telling. A substantial amount of skepticism, perhaps even within the White House, existed about whether the health care legislation did enough on costs. Yet the cost curve in health care is bending more drastically than even I believed possible in the fall of 2009. That’s because the collective impact of the legislation’s individual measures, along with similar changes in the private sector, has produced a shift in perspective and therefore behavior among health care leaders.

This is a significant point Brill fails to acknowledge — to the great detriment of his thesis. Ironically, though, it’s noted toward the end of the book by Gary Gottlieb, the outgoing chief executive of Partners HealthCare in Boston, who says, “There are a lot of problems with Obamacare. But the attention it focused, at least in the industry, on costs with those pilots made a lot of us realize we have to change how we operate.”

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