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Jonathan Cohn's The Ten Year War is the definitive account of the battle over Obamacare, based on interviews with sources who were in the room, from the nation's foremost healthcare journalist. The Affordable Care Act (ACA), better known as "Obamacare," was the most sweeping and consequential piece of legislation to become law in modern American history. It has touched nea Jonathan Cohn's The Ten Year War is the definitive account of the battle over Obamacare, based on interviews with sources who were in the room, from the nation's foremost healthcare journalist. The Affordable Care Act (ACA), better known as "Obamacare," was the most sweeping and consequential piece of legislation to become law in modern American history. It has touched nearly every American in one way or another, for better or worse, and it continues to cost people elections--or win them--ten years later. In The Ten Year War, veteran journalist Jonathan Cohn offers the compelling story of the defining political battle of our time, one that will shape political conversations for decades. At the heart of the book is the decades-old argument over what's wrong with American health care and how to fix it--but it also illuminates what went right, and looks forward to the next big debate over reform. But Cohn goes beyond policy to take a broader look at the profound and dangerous shifts in American politics. An authoritative, comprehensive history, The Ten Year War is a deeper look at how our government became so dysfunctional--and how our national political conversation became so polarized. Drawn from hundreds of hours of interviews and private diaries and memos from the Hill, The Ten Year War is the defining account of a legislative effort and its tumultous aftermath that the United States will be reeling from for decades to come.


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Jonathan Cohn's The Ten Year War is the definitive account of the battle over Obamacare, based on interviews with sources who were in the room, from the nation's foremost healthcare journalist. The Affordable Care Act (ACA), better known as "Obamacare," was the most sweeping and consequential piece of legislation to become law in modern American history. It has touched nea Jonathan Cohn's The Ten Year War is the definitive account of the battle over Obamacare, based on interviews with sources who were in the room, from the nation's foremost healthcare journalist. The Affordable Care Act (ACA), better known as "Obamacare," was the most sweeping and consequential piece of legislation to become law in modern American history. It has touched nearly every American in one way or another, for better or worse, and it continues to cost people elections--or win them--ten years later. In The Ten Year War, veteran journalist Jonathan Cohn offers the compelling story of the defining political battle of our time, one that will shape political conversations for decades. At the heart of the book is the decades-old argument over what's wrong with American health care and how to fix it--but it also illuminates what went right, and looks forward to the next big debate over reform. But Cohn goes beyond policy to take a broader look at the profound and dangerous shifts in American politics. An authoritative, comprehensive history, The Ten Year War is a deeper look at how our government became so dysfunctional--and how our national political conversation became so polarized. Drawn from hundreds of hours of interviews and private diaries and memos from the Hill, The Ten Year War is the defining account of a legislative effort and its tumultous aftermath that the United States will be reeling from for decades to come.

30 review for The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage

  1. 4 out of 5

    Athan Tolis

    Jon Cohn is an old friend. His previous book about why universal health care ought to be considered a universal right, Sick, was a sobering read that had me in tears, but I found it only said one side of the story: that of the suffering we could avoid if the US offered basic universal healthcare. The Ten Year War is a different proposition altogether. Rather than a call to arms, it's a meticulous account. Over some 334 pages you are given the full, unvarnished story of Obamacare. A hundred pages Jon Cohn is an old friend. His previous book about why universal health care ought to be considered a universal right, Sick, was a sobering read that had me in tears, but I found it only said one side of the story: that of the suffering we could avoid if the US offered basic universal healthcare. The Ten Year War is a different proposition altogether. Rather than a call to arms, it's a meticulous account. Over some 334 pages you are given the full, unvarnished story of Obamacare. A hundred pages are first dedicated to previous efforts (and lessons learnt) with special emphasis on the Clintons’ failed attempt, but also offering coverage of everything that came before and after them: it starts as early as Harry Truman, but quickly makes its way to Harry and Louise, a post-mortem on the Clintons’ efforts, moves on to a great review of Romneycare, from there to Obama’s initial half-baked campaign message and concludes by introducing some of the main actors of the next act: Max Baucus, Ted Kennedy, Ron Pollack, Chip Kahn and Liz Fowler (whom I had previously misunderstood as a WellPoint stooge.) The not-so-glorious story of how Obama rammed his legislation through comes next and Jon manages to keep his cool as he walks you through it. You get chapter and verse here, in a super-tight 100 pages. How Rahm Emmanuel never really cared for it, how Obama regardless put together a crew of Jeanne Lambrew, Peter Orzag and Nancy-Ann DeParle to drive the legislation through, his insistence on open procedures when it came to drafting the law. You get the full biographies of all protagonists, the roles they played, how they interacted with one another, the meetings, the anecdotes, the politics, the concessions, the successes and the failures. In the House you’re introduced to John Dingell Jr., Pete Stark, Henry Waxman and his first major concession to the Blue Dogs (a watered down public option.) Next Jon tells the story of how Obama briefly considered tampering with the exclusion of employer-provided healthcare from income tax, before he moves on to the ugliness of the “death panels” and how that fabrication actually turned the electorate against its new president all while the “group of six” Republican members of the House were proving impossible to turn. “There’s plenty of folks who were encouraging him to stand down.” Axelrod is quoting as saying. “He just refused.” The second hero of the book is introduced next and it’s sixty-nine year old Nancy Pelosi. She gets the credit for holding her nose and buying out Bart Stupak’s block of anti-abortionists, but getting two more than the 218 votes needed to push Obamacare through the House, potentially bringing insurance to 35 million more Americans. The fight in the Senate comes next and the story is told of how on one hand Harry Reid got through a tax on the “Cadillac plans,” while on the other hand Lieberman forced him to strike the public option from the bill and how (Nebraska Democrat) Ben Nelson demanded and got special treatment for his state (but killed his career anyway by voting in favor of Obamacare) and how an exhausted Reid accidentally first answered “no” when he was called to vote, but somehow got the minimum necessary 60-39 vote through. Scott Brown’s upset victory in the Massachusetts election that interrupted the effort to marry the two bills is actually previewed “in medias res” at the very beginning of the section and, with the Senate now lost, leaving it as the only choice for the House to approve the (way inferior and less well-thought-out) bill the Senate had originally approved. Nancy Pelosi’s second successful delivery of a result is celebrated in Joe Biden’s words as a “Big ___ing Deal.” In this first couple hundred pages you get a totally balanced presentation of events. Jon takes special care to leave his views out of the picture, shows equal respect to representatives from both sides and does not allow his (very strong) personal opinions to get in the way of what is, in essence, American history. That all goes out the window when he gets to the third part of the book, when he recounts Trump’s efforts to undo Obamacare. By then, he’s bursting to tell you that the legislation is here to stay because it has improved people’s lives. So he drops the pretenses and takes sides. The story is first told of how conservative Chief Justice Roberts stunned his side by choosing to protect the integrity of the Supreme Court over the goals of the Republican party, next of the partially successful efforts to de-fund the new law, followed by the website fiasco, the destruction of the exchanges, the patients who saw their premiums go up, and the section culminates with John McCain’s famous “thumbs down” on the Republican healthcare legislature authored by Paul Ryan. I liked the first two thirds of the book more, but this is regardless a five-star effort: the Ten Year War is the official history of Obamacare.

  2. 4 out of 5

    Jim

    Jonathan Cohn is one of our best policy journalists. His book Sick, published in 2008, was popular with a broad audience and helped advance a consensus among Americans that healthcare reform was needed. In The Ten Year War, Cohn follows up on that book’s depiction of the symptoms of policy failure with a history of how the US addressed and attempted to remedy those failures. While Cohn provides a brief history of previous attempts at universal coverage from the New Deal through to Medicare and t Jonathan Cohn is one of our best policy journalists. His book Sick, published in 2008, was popular with a broad audience and helped advance a consensus among Americans that healthcare reform was needed. In The Ten Year War, Cohn follows up on that book’s depiction of the symptoms of policy failure with a history of how the US addressed and attempted to remedy those failures. While Cohn provides a brief history of previous attempts at universal coverage from the New Deal through to Medicare and then to Clintoncare, the title of his book refers to the fight to enact the Affordable Care Act and the subsequent battles to preserve it. The book is accessible and plainly written, helping to distill complex history and policy for the reader, and I imagine will be well received as a synthetization of the most recent ten-year fight for increased access and affordability in healthcare. In an era of fast news, click bait, and Twitter outrages over issues that change from moment to moment, it is hard to remember the specifics of the healthcare debate from as recently as 2018. For this purpose, I appreciated Cohn’s straight retelling of the fight for Obamacare. In 2021, many forget how difficult it was to pass the ACA in 2010 and even harder to remember that in many cases Democrats were not just negotiating with Republicans but with conservative Democrats to pass something that accomplished twin goals of increasing healthcare coverage and decreasing cost. Cohn reasons that the ACA is the best thing we could have gotten in 2010, and it remains an important accomplishment. While most of the book aims to remind you of the trajectory of the ACA, the most interesting parts are in Cohn’s detailed reporting of actions taken by staffers and policymakers who are not well known in the broad strokes tiktok of healthcare reform. These individuals include Jeanne Lambrew and Nancy-Anne Deparle, who worked largely behind the scenes in unglamorous roles, but bear responsibility for many of the law’s success in conception and action. Cohn aptly points out that many of the actors who were most deeply invested in healthcare policy were women, which recontextualizes the ACA’s history where most of the names remembered are those of the men. This is of course with the exception to Nancy Pelosi, who deserves an incredible amount of credit for stewarding her chamber through the fight for reform. The book’s coda presents a way forward for healthcare politics where things are even more immovable with a conservative party more concerned with communications than legislation. That way forward is learning from this history. The Ten Year War will appeal to readers who already follow Cohn and are interested in healthcare policy. It has broader appeal in its plain use of language and clear explanation of complicated policy. Cohn mercifully doesn’t require “pre-reading” for his audience! Overall, The Ten Year War does an excellent job making the book accessible for all readers. Thanks to NetGalley and St. Martin's Press for the ARC and opportunity to leave a review.

  3. 5 out of 5

    John Saveland

    This is excellent. It’s an insightful, exhaustive dive into the ACA — though “exhaustive” gives maybe the wrong impression; this book is lively, fresh, and quick to read. I was personally interested in examining some of the details of Obamacare (what was accomplished and what wasn’t; what made it into the law and what was abandoned), but it’s more than that: it really digs into why “big legislation” is so difficult, and what it takes to move an idea from philosophy to policy to practice. All that This is excellent. It’s an insightful, exhaustive dive into the ACA — though “exhaustive” gives maybe the wrong impression; this book is lively, fresh, and quick to read. I was personally interested in examining some of the details of Obamacare (what was accomplished and what wasn’t; what made it into the law and what was abandoned), but it’s more than that: it really digs into why “big legislation” is so difficult, and what it takes to move an idea from philosophy to policy to practice. All that said, this isn’t just for fellow policy students. It reads like a novel (though it’s one I knew the ending of... then again, maybe we don’t?) and is certain to pique anyone’s interest. If you have any strong feelings on the Affordable Care Act, this is a must read. Heck, if you don’t have strong feelings, maybe start with this fair, impartial, substantive analysis before you develop a bias. :-)

  4. 5 out of 5

    Lynn

    Good story about the fight for some form of National healthcare. The Democrats getting gun shy after being attacked in 1992 trying National healthcare and the 2003 addition of a prescription benefit to Medicare and finding that they had to rely on themselves as Republicans steadily remove themselves in social responsibility.

  5. 4 out of 5

    Steve Nolan

    A good retelling of recent healthcare battles in the US. (Does still get into the origins - the scope isn't just ten years - but it's not the focus.) A good retelling of recent healthcare battles in the US. (Does still get into the origins - the scope isn't just ten years - but it's not the focus.)

  6. 5 out of 5

    Asha Samuel

    as someone who studied and works in health policy, I know I'm biased but this book was great. it gave the context needed to understand the health care fight and explained both health care and politics in an interesting and accessible way. it was an easy read and one I'd encourage anyone with an interest in understanding modern legislating to read (as Jonathan Cohn writes in his conclusion, the ACA fight is a great case study). no legislation in modern history has had as much of an impact as the as someone who studied and works in health policy, I know I'm biased but this book was great. it gave the context needed to understand the health care fight and explained both health care and politics in an interesting and accessible way. it was an easy read and one I'd encourage anyone with an interest in understanding modern legislating to read (as Jonathan Cohn writes in his conclusion, the ACA fight is a great case study). no legislation in modern history has had as much of an impact as the ACA and I'd recommend even to people who don't necessarily love to think about health policy in their free time.

  7. 4 out of 5

    Austin Barselau

    On the day that a Democratic-led Congress under the auspices of a Democratic president inched one step closer to passing the largest economic relief package in American history, it is worth noting what that bill includes: increased access to and strengthened benefits for the Affordable Care Act-- the most signature health care reform since the President Johnson's Great Society. Its inclusion is surprising, not because of the magnitude of the bill (which is large), but because the fate of the law On the day that a Democratic-led Congress under the auspices of a Democratic president inched one step closer to passing the largest economic relief package in American history, it is worth noting what that bill includes: increased access to and strengthened benefits for the Affordable Care Act-- the most signature health care reform since the President Johnson's Great Society. Its inclusion is surprising, not because of the magnitude of the bill (which is large), but because the fate of the law was so many times held in jeopardy throughout its history; the fact that the ACA still survives (and is now being expanded) is a testament to how precarious its path was. Jonathan Cohn describes that "ten year war" in his most recent book. Cohn's book is an excellent retrospective of the landscape of health care reform, its luminaries, and major political players-- from the mere conceptual stages of how to usher universal coverage to the legislative grinding that enabled its passage. The author, a health care reporter for the Huffington Post, describes the many players on the field in the epic battle for drafting and passing the law, from Harvard and MIT professors, state governments, interest groups, legislative aides, Congressional leaders, and the President and his brain trust-- nearly all of which had personal experiences of their own that underscored the importance to them of health care reform. Cohn's 'The Ten Year War' vividly describes a donnybrook over the ACA that spanned a decade, but that description does not do justice to the century-long campaign to reform American health care. As Cohn writes, this "war" was actually much more prolonged, and its champions were up against "a legacy of failure that had bedeviled similar efforts for nearly a century, and even before the Massachusetts election, they had no margin for error." "Looking back," Cohn concludes, "it's remarkable they passed anything at all." Cohn's book is not a play-by-play recount of the legislative sausage making process, an extensive review of the bureaucratic tinkering or on-the-ground effort to implement (and later, deconstruct) the laws provisions, or a robust public opinion survey of the law's merits or demerits. What it is can be more accurately described as an elucidating thread, colored by the author's many interviews with the key architects and arsonists, of how the ACA came to be and survived after many attempts were made by Republicans on its life. Cohn provides an illuminating chronicle of any important story in the history of American health care reform, and a hard-nosed, scrappy, and nearly ill-fated expose of what Cohn describes as the bleak reality of "what change looks like in America." "The Affordable Care Act is a highly flawed, distressingly compromised, woefully incomplete attempt to establish a basic right that already exists in every other developed nation," he writes. But, he argues, its promise lies in its scope and ambition-- the best piece of legislation that could have passed given the constraints. It is a miracle of how it came to be, and how it mostly remained intact under a volley of assaults. Now, as the COVID-19 relief bill is sailing to President Biden's desk, it's worth reflecting on its legacy, and its renewed promise to increase coverage and to save lives.

  8. 5 out of 5

    Charlie

    This book reminded me why I love biographies so much - you learn not just about the subject, but the broader historical era through that specific lens. The Ten-Year War does the same thing, but for American politics and modern policy-making, through the lens of the Affordable Care Act. It’s one of the best non-fiction books I’ve read in recent memory - in large part because of how well it weaves health care policy theory through the story. The author was a journalist during the Obama / ACA years, This book reminded me why I love biographies so much - you learn not just about the subject, but the broader historical era through that specific lens. The Ten-Year War does the same thing, but for American politics and modern policy-making, through the lens of the Affordable Care Act. It’s one of the best non-fiction books I’ve read in recent memory - in large part because of how well it weaves health care policy theory through the story. The author was a journalist during the Obama / ACA years, and interviewed most of the key players involved (from Obama down through a countless number of Capitol Hill staffers). There’s some acknowledged liberal bias towards universal coverage, but the author does a good job laying out conflicting viewpoints and their rationale. There were three parts to this story - 1. A history of American health care policy from Truman to Clinton - past attempts at reform, and how activism laid the groundwork for ACA. 2. A play-by-play on the ACA legislation process through House/Senate/White House, with all the drama on special interests, policy trade-offs, and vote-inducements involved. 3. The aftermath - the healthcare.gov debacle, broad impact, and countless Republican efforts to repeal/replace the policy On #3 - these Republican rollback efforts were contrasted nicely with how the Democrats originally passed the ACA. Both required the parties to find compromises within a diverse caucus of policy perspectives - but while the Democrats took their time, benefited from a large ecosystem of wonky experts, and reached a flawed-yet-passable bill, the Republicans tried to rush through the process and cared more about the optics of “repeal” than the difficult process of “replace”. They ultimately failed (so far). It’s crazy how politicized this issue became - but the author notes how this was a turning point for American politics. Polarization, tribalism, and non-cooperation became the norm, and the Congress after ACA was very different from the Congress pre-ACA. It’s interesting to understand how much policy and politics are connected - health care policy involves so many levers (individual mandate, coverage standards, cost control, and a complex ecosystem of industry stakeholders), and it’s often about balancing ideal policy theory with political reality. More broadly, it’s clear in the book that politics is extremely unpredictable. There were several points where ACA could have failed, Republicans could have succeeded at repeal, or other outcomes that would have wildly changed our results. I view the (partial) success of ACA as a blueprint for future ambitious policy - and will be better-equipped to understand those future efforts because of this book.

  9. 5 out of 5

    André Crombie

    “As for political risks, Axelrod and Pfeiffer remembered Obama saying, “What are we supposed to do, put our approval rating on the shelf for eight years and admire it?” Thoughts: Two of my most indelible memories are standing in a computer lab in Miami on October 1st, 2013 with hundreds of uninsured folks as healthcare.gov failed to launch, and standing in the same lab several weeks later, crying with and hugging dozens and then hundreds of people getting health insurance, many for the first time “As for political risks, Axelrod and Pfeiffer remembered Obama saying, “What are we supposed to do, put our approval rating on the shelf for eight years and admire it?” Thoughts: Two of my most indelible memories are standing in a computer lab in Miami on October 1st, 2013 with hundreds of uninsured folks as healthcare.gov failed to launch, and standing in the same lab several weeks later, crying with and hugging dozens and then hundreds of people getting health insurance, many for the first time in their lives. The latter experience occurred many, many more times over the ensuing few years (fortunately, the website memory never recurred). This book does a meticulous job of debunking right-wing lies, erasing left-wing misconceptions, and correcting liberal hagiography to settle on truth: “The Affordable Care Act is a highly flawed, distressingly compromised, woefully incomplete attempt to establish a basic right that already exists in every other developed nation. It is also the most ambitious and significant piece of domestic legislation to pass in half a century—a big step in the direction of a more perfect union, and a more humane one as well.” I will always be immensely proud to have been a very minor foot soldier in this piece of history. A few other observations: - On March 23, 2010 (the day the ACA passed), the combined Senate delegations of Arkansas, West Virginia, Montana, North Dakota, South Dakota, Indiana, Louisiana, Iowa, and Nebraska had 13 Democrats and 5 Republicans. Eleven years later, those nine states are represented by 2 Democrats and 16 Republicans. Polarization is a helluva drug. That Democratic Senate majority in 09-10 was so bizarre and interesting. - It was moderate Democrats in the House who were eager and excited (largely for political reasons) about the cost advisory board provision that eventually morphed into the “death panel” lie. Henry Waxman (who is one of the most important and under-discussed public figures of the past few decades) thought it was an immensely dumb idea; it turns out it would never be implemented! - In 2009, a GOP Senator (Mike Enzi) from one of the most Republican states in the union (Wyoming) proposed to a bipartisan group of senators that they agree to a list of negative words they wouldn’t use about each other in public statements. Seven years later his party would nominate a cruel, petty madman best known for rudely pretend-firing people, spreading racist lies about the president on television, and doing mean tweets. Wild. - It’s amazing to think how many folks in 2009 and 2010 said the opposition to President Obama had nothing to do with race (it had everything to do with race!). It’s also startling how obvious it was that the right wing of American politics was rapidly becoming increasingly disconnected from reality and anti-democratic. - Joe Lieberman is a bum.

  10. 4 out of 5

    ManOfLaBook.com

    For more reviews and bookish posts please visit: https://www.ManOfLaBook.com The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage by Jonathan Cohn is a nonfiction account of the political battles to create, and dismantle, the Affordable Care Act (ACA). Mr. Cohn is an author and journalist, writing mainly on US public policy. Love it or hate it, the ACA seemed to have touched a lot of lives, some for better, some for worst. Morever everyone has an opinion on this legislatio For more reviews and bookish posts please visit: https://www.ManOfLaBook.com The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage by Jonathan Cohn is a nonfiction account of the political battles to create, and dismantle, the Affordable Care Act (ACA). Mr. Cohn is an author and journalist, writing mainly on US public policy. Love it or hate it, the ACA seemed to have touched a lot of lives, some for better, some for worst. Morever everyone has an opinion on this legislation, much less one that is grounded in realism, mostly on the basis of political ideology regardless of facts (in my experience). The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage by Jonathan Cohn sketches out the history of healthcare as a public policy from the 1970s to today; in addition to the battles fought in Washington DC about it. Furthermore Universal coverage, as Mr. Cohn points out, was at first a conservative idea. In addition, it aligns very nicely with ideals both Democrats and Republicans can agree on such as self-responsibility, business profitability, and fiscally responsible. As a matter of fact, the author points out the both Presidents Richard Nixon and Ronald Reagan embraced universal healthcare enthusiastically. Additionally, the Republican Party, by far and large, embraced Romneycare’s individual mandate in Massachusetts (transferring the onus from small businesses, to the individual). When President Barak Obama introduced the ACA as his landmark legislation, he found himself defending Republican initiatives against those who previously championed them. The ACA, as we all know, was not perfect. Furthermore, it included some unbelievable lazy passages which were fodder for lawsuits for years to come. In the book, Mr. Cohn takes a good look at this most contentious legislation. This is not a liberal look at the ACA, but a timeline of all the wheeling, dealing, compromises and political maneuvering done by both parties to pass, and later get rid of this legislation.

  11. 5 out of 5

    Barbara Clarke

    Jonathan Cohn is indeed a gifted journalist who has provided us with the sausage making of the ACA or in my ex-insurance exec world O'bummer care. Trigger warning - if you're a committed vegetarian re: single-payer advocate or just a person who is in one of the crap plans being offered now by old Joe - you best not buy this book. It's mildly interesting to see how the whole mess that most of congress never read but passed - with the insurance/hospitals/pharma lobbyists only too happy to provide Jonathan Cohn is indeed a gifted journalist who has provided us with the sausage making of the ACA or in my ex-insurance exec world O'bummer care. Trigger warning - if you're a committed vegetarian re: single-payer advocate or just a person who is in one of the crap plans being offered now by old Joe - you best not buy this book. It's mildly interesting to see how the whole mess that most of congress never read but passed - with the insurance/hospitals/pharma lobbyists only too happy to provide the language. The result is a disgusting - no, pathetic pronouncement by Cohn at the end - hey, this is better than nuttin. In 2021, it's even less better, more expensive, and here's my prediction - get ready Jonathan to document this next chapter - the pre-existing conditions of more Americans that the CDC likes to count will shoot the premiums through the roof, the surprise bills abound, and those who lost whatever crap plan they had will get to have an even crappier plan that will provide the medical oligarchs and lobbyists and congressional bought/sold officials PAC money they never dreamed of to keep it just the way it is. Note - the insurance bandits get a few mentions, the nurses aren't even in the index, and its all about the power of money and some fear of change for the better. I've heard that Social Security was organized on 3x5 cards - pre computer, etc. and those socialist ideas of citizens having a right to decent healthcare that doesn't bankrupt them - we prefer our "uniquely" American debacle. And, one more fierce comment - we DON'T need more books like this - please. There a ton of them out there and the answer is always - you people i.e. patients and those who would give a lot to become one - it's up to you!

  12. 5 out of 5

    Lance

    Do you agree with the Patient Protection and Affordable Care Act (commonly known as Obamacare)? Did you know it was patterned off the healthcare system in Massachusetts (commonly known as Romneycare)? Did you know Romneycare was essentially the result of research conducted by the conservative Heritage Foundation? Did you also know that Republicans in Congress had to repudiate, or ignore, Republican/Conservative involvement in the creation of Romneycare in order to fight viciously against Obamaca Do you agree with the Patient Protection and Affordable Care Act (commonly known as Obamacare)? Did you know it was patterned off the healthcare system in Massachusetts (commonly known as Romneycare)? Did you know Romneycare was essentially the result of research conducted by the conservative Heritage Foundation? Did you also know that Republicans in Congress had to repudiate, or ignore, Republican/Conservative involvement in the creation of Romneycare in order to fight viciously against Obamacare? Can you understand how screwed up that sounds and how we, the citizens, are the biggest losers in these childlike spats? This book helped me truly appreciate the preparation, wheeling and dealing, and total luck involved in getting anything through Congress - especially a divided Congress. I came away with a firm conviction there has to be a better way. I'm not sure I know what it is, but the current system isn't working for us. I understand why it exists, but it isn't working anymore (if it ever really did). You should read this. Seriously. As someone who has spent his whole life on TRICARE, or military medicine, and never having to seriously worry about healthcare coverage at all ever, the systems the majority of people are required to participate in fill me with dread. You can go ahead and keep that level of insecurity if you truly believe it works for you. It's not for me. No thank you.

  13. 4 out of 5

    Sherry

    If you aren't a student of politics or just are thoroughly disgusted by politics this will be a tough book to read even if, like me, you are inherently interested in understanding health care and the ACA issue. Mr. Cohn is meticulous in describing the political process and people involved in getting the ACA passed in 2009/2010. He also describes what the GOP and the think tanks funded by the rich anti government (read Koch Brothers) did to undermine and try to repeal the ACA. It was difficult to If you aren't a student of politics or just are thoroughly disgusted by politics this will be a tough book to read even if, like me, you are inherently interested in understanding health care and the ACA issue. Mr. Cohn is meticulous in describing the political process and people involved in getting the ACA passed in 2009/2010. He also describes what the GOP and the think tanks funded by the rich anti government (read Koch Brothers) did to undermine and try to repeal the ACA. It was difficult to follow much of the time but I attribute that to my lack of political prowess. However, the final chapter "Conclusion" was well worth the effort to read this book. I only wish there were a short, easy-to-understand way to convey this information to the country at large and to hold the GOP and most especially those individuals in the GOP accountable for what they have done to hurt healthcare in America for their political gain and power.

  14. 5 out of 5

    David Potenziani

    If you are interested in health care policy and politics in the US, this is a necessary book. While you might think, based on the title, that its only about the ten years after passage of the ACA, the story is more comprehensive than that. He provides three acts: The growth and mistakes leading up to the Clinton health plan failure; the development and passage of the ACA; and the last ten years. Along the way, he weaves many of the characters involved from his time as a journalist—many accounts If you are interested in health care policy and politics in the US, this is a necessary book. While you might think, based on the title, that its only about the ten years after passage of the ACA, the story is more comprehensive than that. He provides three acts: The growth and mistakes leading up to the Clinton health plan failure; the development and passage of the ACA; and the last ten years. Along the way, he weaves many of the characters involved from his time as a journalist—many accounts told to him in one-on-one interviews. He ably summarizes complex issues in simple language, avoiding much of the jargon often used. Cohn's bias is forthright, he wants universal health care for Americans. This is his telling of what we got right along that path and the lots and lots we got wrong—and still do.

  15. 4 out of 5

    Kyle

    Jonathan Cohn's The Ten Year War is a detailed chronicle of the Affordable Care Act (ACA) including the policy decisions in the decades preceeding its passage, the political challenges of its passage, the evolution of the ACA since then and gaps not addressed by the bill. The book does an excellent job bringing the reader into the moment. You can feel the tension and emotions among the lead lawmakers leading up to the bill being passed. Despite an attempt to stay neutral, you can pick up on some Jonathan Cohn's The Ten Year War is a detailed chronicle of the Affordable Care Act (ACA) including the policy decisions in the decades preceeding its passage, the political challenges of its passage, the evolution of the ACA since then and gaps not addressed by the bill. The book does an excellent job bringing the reader into the moment. You can feel the tension and emotions among the lead lawmakers leading up to the bill being passed. Despite an attempt to stay neutral, you can pick up on some partisan bias in the book, however, it should be nothing new for most folks familiar with healthcare reform over the past decades. Overall a great book, bringing the reader up to speed with the ACA and providing a rich context and history for reform.

  16. 4 out of 5

    Emanuel B

    Cohn’s book is an excellent primer and all-in-one in healthcare. For people who followed healthcare politics closely for the past 12 years I’d say you’ll probably know most of this. This is the book you gift to your less legislatively informed friend who believes that the Democrats could have done more with their 2008 majorities but deliberately and willfully chose to stop short, or that the nation’s first black President could have weaponized access to his office to force the press corps to swa Cohn’s book is an excellent primer and all-in-one in healthcare. For people who followed healthcare politics closely for the past 12 years I’d say you’ll probably know most of this. This is the book you gift to your less legislatively informed friend who believes that the Democrats could have done more with their 2008 majorities but deliberately and willfully chose to stop short, or that the nation’s first black President could have weaponized access to his office to force the press corps to sway Lieberman on a public option.

  17. 4 out of 5

    Patricia |

    Meticulously researched while still written in an accessible narrative, The Ten Year War chronicles the history of the Affordable Care Act - and more broadly health policy in the US over time. Even having lived through it as an interested and careful observer (working in health policy though not in politics), I learned so much. Lots of good lessons learned for progressive policy making doing forward as well. Thanks to St Martins Press and NetGalley for the early copy in exchange for an honest rev Meticulously researched while still written in an accessible narrative, The Ten Year War chronicles the history of the Affordable Care Act - and more broadly health policy in the US over time. Even having lived through it as an interested and careful observer (working in health policy though not in politics), I learned so much. Lots of good lessons learned for progressive policy making doing forward as well. Thanks to St Martins Press and NetGalley for the early copy in exchange for an honest review.

  18. 4 out of 5

    Cameron Carr

    For a book about health care legislation it’s surprisingly engaging and quick to read. Cohn gives ample attention to the characters and how their backgrounds and personalities contribute to the story to create a narrative. This book serves more as a history of America’s push toward universal healthcare than an argument for reform, though that’s certainly implied throughout. Though that may sound less exciting, it explains how the intricacies and oddities of our health care system came to be and For a book about health care legislation it’s surprisingly engaging and quick to read. Cohn gives ample attention to the characters and how their backgrounds and personalities contribute to the story to create a narrative. This book serves more as a history of America’s push toward universal healthcare than an argument for reform, though that’s certainly implied throughout. Though that may sound less exciting, it explains how the intricacies and oddities of our health care system came to be and the conflict between what’s probably best and what’s politically possible.

  19. 4 out of 5

    Hasan

    Jonathan Cohn does an incredible job explaining the behind-the-scenes work and commitment Democrats and Democratic-allied groups had toward healthcare reform. Whenever the Democrats didn't have the White House, their allies were working on healthcare-related reforms and getting political buy-in so that they'd be able to pass laws when in power. This culminated with the passage of the Affordable Care Act in 2010 and the lack of the aforementioned work was a huge reason healthcare repealed failed Jonathan Cohn does an incredible job explaining the behind-the-scenes work and commitment Democrats and Democratic-allied groups had toward healthcare reform. Whenever the Democrats didn't have the White House, their allies were working on healthcare-related reforms and getting political buy-in so that they'd be able to pass laws when in power. This culminated with the passage of the Affordable Care Act in 2010 and the lack of the aforementioned work was a huge reason healthcare repealed failed in 2017.

  20. 5 out of 5

    Misanthropic Hermit

    Despite my keen interest in the topic, half-way through this book I had to abandon it because it's written in a very dry, clinical way, with an overabundance of details. I imagine this book would be useful as a reference for a student working on a Master thesis, or a journalist researching this topic. Only a person with a photographic memory can keep track of the myriad of names and figures mentioned in the book. Despite my keen interest in the topic, half-way through this book I had to abandon it because it's written in a very dry, clinical way, with an overabundance of details. I imagine this book would be useful as a reference for a student working on a Master thesis, or a journalist researching this topic. Only a person with a photographic memory can keep track of the myriad of names and figures mentioned in the book.

  21. 5 out of 5

    Celeste

    Packed with detail and hard to put down. Deepened my respect for Obama, Clinton(s), Sanders, McCain, and Romney. In a nutshell, "[t]he Affordable Care Act is a case study in how policymaking works today, and the deep dysfunctions of American politics that will surely affect any similarly ambitious reform efforts in the future." Packed with detail and hard to put down. Deepened my respect for Obama, Clinton(s), Sanders, McCain, and Romney. In a nutshell, "[t]he Affordable Care Act is a case study in how policymaking works today, and the deep dysfunctions of American politics that will surely affect any similarly ambitious reform efforts in the future."

  22. 4 out of 5

    Hill Krishnan

    My top 3 books on healthcare. This goes into the stories of the political actors’ motivations on both sides of the aisle, nuts and bolts of health care policy and the political will to achieve one goal —to give coverage to 20 million uninsured Americans. What a dramatic show and shows the reader why Biden is correct in saying “This is a big f***ing Deal”!

  23. 4 out of 5

    Ryan Levi

    “It is not nearly good enough, and yet so much better than what came before it. In America, that is what change looks like.” A thorough yet incredibly readable and fascinating history of the fight for and against the Affordable Care Act. So so good.

  24. 4 out of 5

    Jonathan Gruber

    Probably a lower rating if you didn't live this personally! But actually reads really well for a book about the wonky process of policy making. Amazing how many close calls the law survived! Probably a lower rating if you didn't live this personally! But actually reads really well for a book about the wonky process of policy making. Amazing how many close calls the law survived!

  25. 5 out of 5

    Fraser Kinnear

    Quite similar to "America's Bitter Pill". I wish there was more on the Trump-era developments. Quite similar to "America's Bitter Pill". I wish there was more on the Trump-era developments.

  26. 5 out of 5

    Colin

    An absolutely excellent read. Well researched and expertly written. I would not have guessed a book about American healthcare policy could be so riveting.

  27. 5 out of 5

    Miguel

    Very detailed background on the road to the ACA. Lots and lots of detail on the congressional & executive branch sausage making and the trials & tribulations to getting approved.

  28. 4 out of 5

    Aleka

    A gripping, highly readable account of the passage of the ACA and subsequent attempts to repeal the law. Highly recommend if you’re interested in health policy / politics.

  29. 5 out of 5

    Ben

    A well written and comprehensive history of Obamacare and the fights over it for the following years. Definitely the book that has the most people I know mentioned in it.

  30. 5 out of 5

    Richard

    Good history of attempts at universal health care. Details how the party of NO offers no alternatives other than obstruction.

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